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Updated: Aug 15, 2026
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Published on: June 2, 2022
Modified calcaneal index: a new screening tool for osteoporosis based on plain radiographs of the calcaneum
K C Pande1, S K Pande, D de Takats
1Sushrut Hospital, Research Centre and PGI Orthopaedics, Ramdaspeth, Nagpur, India. ketanpande@yahoo.com
Purposes:
To assess osteoporosis using plain radiography of the calcaneum by studying the performance characteristics of the modified calcaneal index through inter- and intra-observer agreement. To study the correlation of the modified calcaneal index to quantitative ultrasound of the calcaneus and bone mineral density (BMD) of the femoral neck and distal radius.
Methods:
Lateral calcaneal radiographs of 252 women who participated in a clinical trial for osteoporosis were reviewed. The BMD of the hip and distal radius was measured and the calcanea were assessed using ultrasound. The calcaneal radiographs were graded by 3 clinicians according to a previously described 5-grade calcaneal index. A modified 3-grade calcaneal index was then developed.
Results:
The highest scores of intra- and inter-observer reliability of the modified calcaneal index were 0.45 and 0.40, respectively, which were higher than those of the 5-grade calcaneal index. The correlation of the modified calcaneal index with other measures was significant (hip BMD, r=0.31; distal radius BMD, r=0.28; calcaneal speed of sound, r=0.20; broadband ultrasound attenuation, r=0.36) [p<0.005]. There were significant differences in hip BMD, distal radial BMD, calcaneal speed of sound, and broadband ultrasound attenuation between the 3 grades of the modified calcaneal index (Kruskal-Wallis 1-way ANOVA; p<0.0001).
Conclusion:
The modified calcaneal index can be used to measure bone structure and skeletal strength and is a suitable screening tool for osteoporosis in places where advanced approaches to bone-status assessment are not available.
