Osteoporosis: diagnosis by plain chest film versus dual photon bone densitometry

Readers of chest radiographs often comment on the presence of osteoporosis. We have hypothesized that diagnoses of osteoporosis from chest films are not reliable even when made by experienced radiologists. To test this hypothesis, we had nine radiologists estimate the degree of bone density seen on 45 lateral chest films. We compared their estimates of bone density to the results of dual photon bone densitometry of the lumbar spine. We found that there was little ability to accurately diagnose osteoporosis by chest film since the group of nine readers achieved accuracies ranging from 0.59 to 0.64. Therefore, we feel it is unjustified to comment upon the presence or absence of osteoporosis on the basis of chest films.