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Reliability of Singh's Index and Calcaneal Index in Assessing Osteoporosis Compared with Quantitative Ultrasound Bone
Rashmi Jain1, Vipin Mishra2, Ankit Jain1
1Department of Pathology, Government Medical College, Satna, Madhya Pradesh, India.
Introduction:
Osteoporosis is a major global health problem characterized by reduced bone mass and increased fracture risk. Dual-energy X-ray absorptiometry is the gold standard for bone mineral density (BMD) measurement; however, its cost and limited accessibility restrict its use in low- and middle-income countries. Singh's Index and Calcaneal Index, based on trabecular bone patterns on radiographs, have been proposed as inexpensive alternatives.
Materials And Methods:
A prospective study was conducted during an orthopedic camp in October 2024. A total of 120 skeletally mature patients underwent hip and calcaneal radiographs, which were independently graded by four orthopedic surgeons using Singh's and Calcaneal indices. BMD was measured using quantitative ultrasound (QUS) at the femoral neck and calcaneus. Agreement was assessed using weighted Cohen's kappa statistics, and the correlation between indices and BMD was analyzed.
Results:
Intraobserver agreement for Singh's Index was substantial (κ = 0.63-0.88), whereas interobserver agreement was poor to moderate (κ = 0.15-0.54). The Calcaneal Index showed similar variability. Correlation between the indices and QUS-derived BMD was weak, indicating limited diagnostic accuracy.
Conclusion:
Singh's Index and Calcaneal Index demonstrate poor reproducibility and weak correlation with quantitative BMD. While inexpensive, their subjectivity limits clinical utility. QUS offers a more reliable, affordable alternative for osteoporosis screening in resource-limited settings.
