The use of radiographic hip scores for the initial diagnosis of the osteoporosis: is the bone densitometry (DXA) essential?

Abstract

Objective: Osteoporosis is a set of direct consequences of the skeletal homeostasis disorder, culminating with decreased bone strength, bone quality deterioration and ultimately fractures at minimum trauma. The increased longevity detected not only in Brazil but worldwide, is one of the main risk factors for developing the disease. It is estimated that Brazil, in mid-2050, will have approximately eight million people over 60 years; 68.3% of the total will be formed by the female, which is the main target of osteoporosis. With the increasing elderly population, it is necessary to think about strategies for these individuals reach senescence with quality of life and autonomy. For this new group of individuals over 60 years can enjoy such longevity, it is needed to invest in health promotion, especially avoiding the dreaded pathological osteoporosis fractures. The amount of bone or bone mineral density (BMD) reflects mainly the concentration of calcium in its composition, and it may be fully assessed by bone densitometry (DXA). Unfortunately, waiting lists for these exams are long, not to mention the high financial costs, at the expense of simpler tests, such as radiography. Thus, based on such information, in the long queues for bone densitometry tests, the costs incurred to public coffers, not only for the treatment of fractures and sequelae caused by osteoporosis, but also by the value of diagnostic tests, the authors propose the following study, that main objective will be to compare the analysis results of the radiographic parameters of hip region with the results of bone densitometry exams, under the following aspects: Cortical Thickness Ratio, Proportion Channel:Calcar, Dorr Geometric Classification, T-score, Z-score, Body Mass Index. Patients and Methods: The sample size was predetermined at baseline, coming to a total minimum of 480 participants. All female Caucasian patients, over 60 years, which reach the Orthopaedics clinics, Geriatrics and Internal Medicine at the Marilia State Medical School, for reasons unrelated to the hip region, will be selected for this study, responding to Osteoporosis Assessment Questionnaire. Patients who are already under treatment for osteoporosis, patients with a history of systemic musculoskeletal disease (Paget's disease, rheumatoid arthritis, lupus, etc.), bone surgery or bedridden for the past six months will be excluded from the study. The following patients will be sent to the realization of digital radiographs of the dominant hip, as well as bone densitometry. The results will be analyzed after all patients have been subjected to imaging tests, whereupon the found values will be compared. Rationale: The results will provide new lines of research and prevention of pathological fractures due to osteoporosis. It is also intended to decrease the financial costs of the fractures treatment and the rates of sequels.