The clinical necessity of a distal forearm DEXA scan for predicting distal radius fracture in elderly females : a retrospective case-control study

Abstract

Abstract Background: Recent studies have demonstrated that the distal forearm dual-energy X-ray absorptiometry (DEXA) scan might be a better method for screening bone mineral density (BMD) and the risk of distal forearm fracture, compared with a central DEXA scan. Therefore, the purpose of this study was to determine the effectiveness of a distal forearm DEXA scan for predicting the occurrence of distal radius fracture (DRF) in elderly females who were not initially diagnosed with osteoporosis after a central DEXA scan. Methods: Among the female patients who visited our institutes and who were over 50 years old and underwent DEXA scans at 3 sites (lumbar spine, proximal femur, and distal forearm), 228 patients with DRF (group 1) and 228 propensity score-matched patients without fractures (group 2) were included in this study. The patients’ general characteristics, BMD, and T-scores were compared. Odds ratios (OR) of each measurement and correlation ratio among BMD values of the different sites were evaluated. Results: The distal forearm T-score of the elderly females with DRF (group 1) was significantly lower than that of the control group (group 2) (p < 0.001 for the one third radius and ultradistal radius measurements). BMD measured during the distal forearm DEXA scan was a better predictor of DRF risk than BMD measured during the central DEXA (OR = 2.33; p = 0.031 for the one third radius, and OR = 3.98; p < 0.001 for the ultradistal radius). The distal one thirds radius BMD was correlated with hip BMD, rather than lumbar BMD (p < 0.05 in each group). Conclusion: Performing a distal forearm DEXA scan in addition to a central DEXA scan appears to be clinically significant for detecting the low BMD in the distal radius, which is associated with osteoporotic DRF in elderly females. Level of evidence: III; case-control study.