• 1

    National Osteoporosis Foundation: Fast facts on osteoporosis. Available at: http://www.nof.org/osteoporosis/stats.htm. Accessed February 26. ,2007. .

  • 2

    Caliri A, De Filippis L, Bagnato GL, et al: Osteoporotic fractures: mortality and quality of life. .Panminerva Med 49::21. ,2007. .

  • 3

    United States Department of Health and Human Services: Bone health and osteoporosis: a report of the surgeon general. October 2004. Available at: http://www.surgeongeneral.gov/library/bonehealth. Accessed February 20. ,2007. .

  • 4

    Sinnott B, Kukreja S, Barengolts E: Utility of screening tools for the prediction of low bone mass in African American men. .Osteoporosis Int 17::684. ,2006. .

    • Search Google Scholar
    • Export Citation
  • 5

    Wendling P: WHO considers change in osteoporosis criteria. .Clin Endocrinol News 1::13. ,2006. .

  • 6

    National Institutes of Health: Osteoporosis prevention, diagnosis, and therapy. .NIH Consensus Statements 17::1. ,2000. .

  • 7

    Henry MJ, Pasco JA, Sandars KM, et al: Fracture risk (FRISK) score: Geelong Osteoporosis Study. .Radiol 241::190. ,2006. .

  • 8

    Hans D, Downs RW Jr, Duboeuf F, et al: Skeletal sites for osteoporosis diagnosis: the 2005 ISCD official positions. .J Clin Densitom 9::15. ,2006. .

  • 9

    Leslie WD, Tsang JF, Caetano PA, et al: Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. .J Clin Endocrinol Metab 92::77. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    World Health Organization Study Group: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843. Geneva: WHO:. 1994. .

  • 11

    Gallacher SJ, Gallagher AP, McQuillian C, et al: The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. .Osteoporos Int 18::185. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. .Endocr Pract 9::544. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kaptoge S, Armbrecht G, Felsenberg D, et al: When should the doctor order a spine x-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). .J Bone Miner Res 19::1982. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Singh M, Nagrath AR, Maini PS: Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. .J Bone Joint Surg Am 52::457. ,1970. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Jhamaria NL, Lal KB, Udawat M, et al: The trabecular pattern of the calcaneum as an index of osteoporosis. .J Bone Joint Surg Br 65::195. ,1983. .

  • 16

    Pande KC, Pande SK, de Takats D, et al: Modified calcaneal index: a new screening tool for osteoporosis based on plain radiographs of the calcaneum. .J Orthop Surg 13::27. ,2005. .

    • Search Google Scholar
    • Export Citation
  • 17

    Ojo F, Al Snih S, Ray LA, et al: History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans. .J Natl Med Assoc 99::412. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Looker AC: Body fat and vitamin D status in black versus white women. .J Clin Endocrinol Metab 90::635. ,2005. .

  • 19

    Freedman BA, Potter BK, Nesti LJ, et al: Missed opportunities in patients with osteoporosis and distal radius fractures. .Clin Orthop Relat Res 454::202. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 285: 785. ,2001. .

    • Crossref
    • Export Citation
  • 21

    Borah B, Gross GJ, Dufresne TE, et al: Three-dimensional microimaging (MRmicrol and microCT) finite element modeling, and rapid prototyping provide unique insights into bone architecture in osteoporosis. .Anat Rec 265::101. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Delmas PD, Marin F, Marcus R, et al: Beyond hip: importance of other nonspinal fractures. .Am J Med 120::381. ,2007. .

  • 23

    Hasselman CT, Vogt MT, Stone KL, et al: Foot and ankle fractures in elderly white women. Incidence and risk factors. .J Bone Joint Surg Am 85::820. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Blonk MC, Erdtsieck RJ, Wernekinck ME, et al: The fracture and osteoporotic clinic: 1-year results and 3-month compliance. .Bone 40::1643. ,2007. .

  • 25

    Ito Z, Harada A, Matsui Y, et al: Can you diagnose for vertebral fractures correctly by plain x-ray? Osteoporos Int 17: 1584. ,2006. .

    • Crossref
    • Export Citation
  • 26

    Casez P, Uebelhart B, Gaspoz JM, et al: Targeted education improves the very low recognition of vertebral fractures and osteoporosis management by general internists. .Osteoporos Int 17::965. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    McLellan AR, Gallacher SJ, Fraser M, et al: The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fractures. .Osteoporos Int 14::1028. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Schwartz EN, Steinberg D: Detection of vertebral fractures. .Curr Osteoporos Rep 3::126. ,2005. .

  • 29

    Link TM, Guglielmi G, van Kuijk C, et al: Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. .Eur Radiol 15::1521. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Low Bone Mass and Fractures on Foot Radiographs: Missed Opportunities to Evaluate for Osteoporosis

A Pilot Study

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  • 1 Division of Endocrinology, Department of Internal Medicine, Howard University, College of Medicine, Washington, DC.
  • | 2 Department of Podiatry, Howard University Hospital, Washington, DC.
  • | 3 Department of Radiology, Howard University Hospital, Washington, DC.
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Background: Osteoporosis is often unrecognized, even in the presence of radiologic evidence of vertebral or nonvertebral fragility fractures.

Methods: Ninety patients aged 50 years and older with radiographs of the foot taken at Howard University Hospital between 2003 and 2005 were randomly selected. In phase 1, standard radiograph reports were reviewed for evidence of osteopenia, fractures, or both. In phase 2, risk factors for osteoporosis and dual energy x-ray absorptiometry scans were obtained.

Results: In phase 1, radiologists reported all of the fractures for all 90 participants; however, osteopenia was reported in only 54.7% of these. In phase 2, for 50% of the participants with radiographic evidence of osteopenia, fractures, or both, there was no evidence that the clinicians evaluated risk factors for low bone mass or requested a dual energy x-ray absorptiometry scan. Of participants who had radiographic evidence of osteopenia, osteoporosis, or both, 83.3% met the criteria for dual energy x-ray absorptiometry scans.

Conclusions: Osteopenia or fracture observed on radiographs of the foot are predictive of low bone mass but are often not evaluated. (J Am Podiatr Med Assoc 99(1): 1–7, 2009)

Corresponding author: Juanita A. Archer, MD, Division of Endocrinology, Department of Internal Medicine, Howard University, College of Medicine, 2041 Georgia Ave, NW, Washington, DC 20060. (E-mail: jjaharcher@aol.com)