Subjective assessment of bone health from wrist radiographs

Introduction

Osteoporosis is a prevalent condition associated with increased fracture risk, significantly impacting quality of life. Dual X-ray Absorptiometry (DXA) is the standard for diagnosing osteoporosis, but with challenges for timely access. This study aimed to assess the agreement between subjective clinician evaluations of wrist radiographs for radiographic osteopenia and objective DXA-based bone mineral density (BMD) measurements, to assess the role diagnostic radiographers and reporting clinicians might play in early detection of poor bone health.

Methods

Using a survey approach, 104 radiology-related clinicians assessed 28 anonymized posterior-anterior wrist radiographs. The study evaluated participants agreement of radiographic osteopenia assessment with objective DXA assessment for osteopenia/osteoporosis diagnosis. Agreement between participants, and response reliability were also investigated utilising four repeat cases within the dataset. Subgroup analysis was performed based on professional role, clinical experience and if currently in a formal reporting role. Qualitative feedback on clinical understanding of radiographic osteopenia was collected.

Results

Results generally indicated poor agreement between assessment of radiographic osteopenia, and subsequent DXA outcomes (percentage agreement 51 % (SD 10 %; range 25–79 %). There was poor agreement between respondents, and no statistically significant associations in performance with professional role, experience level, or reporting status. Qualitative responses indicated diverse clinical approaches to identifying radiographic osteopenia, with a focus on bone density, cortical features, and patient age.

Conclusion

The results suggest limited reliability of subjective radiographic assessments compared to DXA, suggesting the need for improved consistency in clinical evaluations.

Implications for practice

This study underscores the importance of objective BMD measurements over subjective assessments in detecting early osteoporosis, advocating for further research into sstandardisation and training on subjective assessments of bone health and the clinical implications.