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Metacarpal radiographic indices in the assessment of bone strength and fracture risk.

Vasireddy, Sreekanth (2010) Metacarpal radiographic indices in the assessment of bone strength and fracture risk. M.D. thesis, University of Sheffield.

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Osteoporotic fractures are associated with morbidity and increased mortality, and treating fractures is an increasing expenditure for national health systems. Targeting fracture preventative measures appropriately starts with finding those at risk of fracture, services for which can be expensive and poorly available. Metacarpal morphometry can potentially be an inexpensive and widely available method of skeletal strength assessment. In this study a semi-automated metacarpal morphometry (SMCM) technique and a fully automated digital x-ray radiogrammetry (OXR) technique were studied for fracture prediction ability. 9 OXR was studied in a nested case-control setting with hip fracture patients and controls (Hip fracture Prevention Study, HIPS), and OXR bone mineral density (BMO) and OXR metacarpal index (MCI) were found to predict hip fracture risk (odds ratio, OR 1.79 and 1.72 respectively for 1 standard deviation (SO) decrease in measurement). OXR was also studied in a prospective setting for vertebral fracture prediction (Vertebral Osteoporosis Trial), and OXR-BMO and OXR-MCI were found to predict vertebral fracture risk (OR 1.56 and 1.81 respectively). SMCM was studied in a prospective setting (HIPS), and average MCI of 6 metacarpals (AMCI) was found to predict all fracture risk and hip fracture risk (OR 1.30 and 1.42 respectively), but not clinical vertebral fracture risk. In all these settings however, hip, spinal and forearm OXA measures had similar or higher point estimates for the respective fracture risk predictions. There was a trend for disproportionately greater bone loss with age at the metacarpals by MCM measures, compared to hip or forearm OXA measures, especially when associated with other medical conditions such as rheumatoid arthritis. Although MCM measures were not superior to OXA measures in fracture risk prediction, there may be a useful role for them in epidemiological studies or providing a clinical service where access to OXA is limited.

Item Type: Thesis (M.D.)
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Medicine (Sheffield)
Identification Number/EthosID: uk.bl.ethos.573095
Depositing User: EThOS Import Sheffield
Date Deposited: 29 Nov 2016 16:27
Last Modified: 29 Nov 2016 16:27
URI: http://etheses.whiterose.ac.uk/id/eprint/14584

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