Are Orthopedic Surgeons’ Subjective Intraoperative Conclusions About Bone Mass Accurate?

Abstract

Objective: To validate orthopedic surgeons’ subjective estimation of bone mineral density and presence of osteoporosis against the gold standard, dual x-ray absorptiometry (DXA). Methods: Orthopedic surgeons were asked immediately postoperatively to evaluate the quality of patients’ bone using a 10-cm visual analog scale (VAS) ranging from very poor to extremely high bone quality. They were also asked to conclude whether the bone was osteoporotic, or if they were unable to answer. Within 3 months postoperatively, all patients underwent DXA to measure their bone mineral density. Receiver operating characteristic (ROC) curves were used as diagnostic tools to describe the accuracy of the VAS score against the presence of osteoporosis based on DXA or the bone status category (normal, osteopenic or osteoporotic). Results: Fifty-three patients were included. Areas under the ROC curves for measuring the accuracy of the VAS were 0.73 for diagnosing abnormal bone status (osteopenia and osteoporosis, and 0.70 for diagnosing osteoporosis. When using a cutoff point of ≤ 4 cm on the VAS for diagnosing osteoporosis, the sensitivity was 85%, specificity was 42%, and 75% of patients were correctly classified. The positive predictive value of the surgeons’ conclusion of osteoporosis was 50%, and the negative predictive value was 83%. Conclusion: Orthopedic surgeons are in relation to performing surgery on fractures able to distinguish normal from abnormal bone with fair accuracy. Level of evidence: Prospective cohort study, level II.