J Bone Metab.  2020 Nov;27(4):261-266. 10.11005/jbm.2020.27.4.261.

The 2nd Metacarpal Cortical Index as a Simple Screening Tool for Osteopenia

• Patel B
• Aqil A
• Riaz O
• Jeffers R
• Dickson D

• KMID: 2511057
• DOI: http://doi.org/10.11005/jbm.2020.27.4.261

Abstract

Background
Osteopenia is a known risk factor for sustaining skeletal fractures. Prevention of fragility fractures has obvious clinical and economic advantages, however screening all patients using a dual energy X-ray absorptiometry (DXA) is controversial not only because of the cost implications but also because it would potentially involve exposing a percentage of normal patients to unnecessary radiation. We wished to assess whether a simple hand X-ray measuring the 2nd metacarpal cortical index (2MCI) could be used as a simple screening tool for identifying patients with osteopenia.
Methods
We retrospectively collected the radiographic data of 206 patients who had a simple radiograph of the hand and a DXA scan within one year of each other from our picture archiving and communication system database. The 2MCI was calculated for all patients. As data was parametric, a Pearson’s correlation was performed to assess association between Tscores and 2MCI. Further analysis involved the construction of receiver operating characteristic (ROC) curves to identify a 2MCI index, which would give the most appropriate sensitivity and specificity values for identifying the presence of osteopenia.
Results
A statistically significant and moderate correlation between DXA T-scores and 2MCI values was found (r=0.54, n=206, P<0.001). Further ROC curve analysis of normal and osteopenic subjects identified that a 2MCI of 41.5 had a sensitivity of 100% and specificity of 53% for detecting osteopenia.
Conclusions
Our results support the use of the 2MCI as a simple screening tool for identifying patients with osteopenia.

Keyword

Bone diseases, metabolic; Metacarpus; Osteoporosis; Radiography