Radiography Axial Skeleton There is insufficient evidence to support the current use of radiography as a screening tool in patients suspected of having osteoporosis or low BMD. Reportedly, patients with a low second metacarpal index may have a higher risk for developing hip fractures [40]. A recent study using artificial intelligence to segment metacarpal morphometry has shown potential as a screening tool with a sensitivity of 82.4% and specificity of 95.7% and a pipeline accuracy of nearly 94% [41]. Patients who have radiographic evidence of demineralization and/or fragility fractures should be referred to DXA for further characterization. SXA There is insufficient evidence to support the current use of single X-ray (SXA) in patients suspected of having osteoporosis or low BMD. SXA is a projectional X-ray-based technology that used one X-ray tube as a photon source and was shown to precisely measure BMD at the forearm. It is no longer widely used in current practice and has been supplanted by DXA. TBS Although DXA provides an accurate evaluation of BMD, it is not always an accurate predictor of fracture risk because there is considerable overlap between BMD values in individuals with and without fractures. Trabecular bone score (TBS) is an independent predictor of fracture risk because TBS values quantify bone microarchitecture, a determinant of bone strength [42]. This analytical tool performs textural analysis on 2-D lumbar spine DXA images and captures information by measuring grey-level variations from one pixel to adjacent pixels, providing 3- D bone characteristics such as trabecular number, trabecular separation, and the connectivity density [43]. There is evidence that TBS can differentiate between two 3-D microarchitectures that exhibit identical BMD measurements bone quality rather than bone quantity as measured by DXA, QCT, and ultrasound.
Osteoporosis and Bone Mineral Density. Radiography Axial Skeleton There is insufficient evidence to support the current use of radiography as a screening tool in patients suspected of having osteoporosis or low BMD. Reportedly, patients with a low second metacarpal index may have a higher risk for developing hip fractures [40]. A recent study using artificial intelligence to segment metacarpal morphometry has shown potential as a screening tool with a sensitivity of 82.4% and specificity of 95.7% and a pipeline accuracy of nearly 94% [41]. Patients who have radiographic evidence of demineralization and/or fragility fractures should be referred to DXA for further characterization. SXA There is insufficient evidence to support the current use of single X-ray (SXA) in patients suspected of having osteoporosis or low BMD. SXA is a projectional X-ray-based technology that used one X-ray tube as a photon source and was shown to precisely measure BMD at the forearm. It is no longer widely used in current practice and has been supplanted by DXA. TBS Although DXA provides an accurate evaluation of BMD, it is not always an accurate predictor of fracture risk because there is considerable overlap between BMD values in individuals with and without fractures. Trabecular bone score (TBS) is an independent predictor of fracture risk because TBS values quantify bone microarchitecture, a determinant of bone strength [42]. This analytical tool performs textural analysis on 2-D lumbar spine DXA images and captures information by measuring grey-level variations from one pixel to adjacent pixels, providing 3- D bone characteristics such as trabecular number, trabecular separation, and the connectivity density [43]. There is evidence that TBS can differentiate between two 3-D microarchitectures that exhibit identical BMD measurements bone quality rather than bone quantity as measured by DXA, QCT, and ultrasound.