Improving Bone Mineral Density Screening by Using Digital X-Radiogrammetry Combined With Mammography.

Area of Science:

• Geriatric Medicine
• Radiology
• Endocrinology

Background:

• Fracture risk assessment in postmenopausal women is currently suboptimal.
• Most women undergo screening mammography, presenting an opportunity for integrated bone density screening.
• Digital X-radiogrammetry (DXR) measures bone mineral density (BMD) using metacarpal shaft imaging, feasible on mammography units.

Purpose of the Study:

• To evaluate the correlation between DXR and dual-energy X-ray absorptiometry (DXA) in postmenopausal women undergoing mammography.
• To identify optimal DXR thresholds for triaging women to central DXA screening for osteoporosis.
• To assess the feasibility and workflow impact of integrating DXR into mammography screening.

Main Methods:

• A cohort of 200 postmenopausal women over 50 years old underwent mammography, DXR, and DXA.
• Agreements between DXR and DXA T-scores were analyzed using receiver operator characteristic (ROC) curves and Lin's concordance correlation coefficient.
• Youden's method determined optimal DXR T-score thresholds to predict osteoporosis by DXA.

Main Results:

• 77.5% of women had DXA T-scores ≤ -1, indicating osteopenia or osteoporosis.
• DXR T-scores showed good agreement with DXA T-scores (77%).
• A DXR T-score > -1.98 demonstrated a 94% negative predictive value for osteoporosis by DXA, with minimal workflow impact (5 minutes added per patient).

Conclusions:

• Integrating DXR into mammography screening can effectively triage postmenopausal women for osteoporosis assessment.
• Using a DXR T-score threshold of < -1.98 can identify a significant proportion of at-risk women.
• This approach has the potential to improve current low rates of osteoporosis screening and fracture risk evaluation.