Online Program

280214
Risk factors for osteoporosis on foot x-rays


Tuesday, November 5, 2013 : 3:00 p.m. - 3:30 p.m.

Michael Kelly, BS, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, Dedham, MA
Adam Fleischer, DPM, MPH, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
Steven Herwick, MD, Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago
Martin Yorath, DPM, Department of Podiatric Surgery & Applied Biomechanics, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
Daniel Evans, DPM, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
Mitchell Cook, DPM, Podiatric Medicine & Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL
Robert Joseph, DPM, PhD, FACFAS, Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
PURPOSE: It is uncertain whether, and to what extent, plain film radiographs of the foot can be used to estimate systemic bone mineral density. The purpose of this study is to clarify whether previously described pedal radiographic findings can be used to help identify women at risk for osteoporosis and osteoporotic fracture.

METHODS: Several commonly described pedal radiographic features of low BMD (e.g., cortical thinning, presence of prominent primary trabeculae, etc.) will be examined with clinically known risk factors for osteoporosis in a multivariable analysis using bone densitometry (DEXA scan) as the reference standard.

Adult women between the ages of 45 and 65 years with a DEXA scan result of either ‘osteoporosis' or ‘normal total bone mineral density' will be invited to participate. Data will be collected from 50 patients with osteoporosis and 50 controls matched on age (+/- 3 yrs). Following their DEXA scan, subjects will undergo standing AP and lateral X-rays of their dominant foot. AP radiographs will be evaluated for CCT, PCA, MI, PPT, and IS. Lateral radiographs will be used to obtain values for Jhamaria's calcaneal index (grades 1-5) and the modified calcaneal index (grades 1-3).

ANALYSIS: Conditional mutivariable logistic regression will be used to identify important radiographic (e.g., CCT) and/or clinical (e.g., smoking status) predictor variables for osteoporosis.

SIGNIFICANCE: Establishing pedal radiographic risk factors using an at-risk population (older adult women [<65] where routine densitometry screening is not yet recommended) may assist providers and radiologists in identifying patients with osteoporosis earlier in their disease course.

Learning Areas:

Clinical medicine applied in public health
Public health or related research

Learning Objectives:
Demonstrate if, and to what extent, specific radiographic features observed on foot X-rays can help to identify women at increased risk for osteoporosis and osteoporotic fracture.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a second year podiatric medical student and this work is a part of my Swanson Independent Scholar research at the Dr. William M. Scholl College of Podiatric Medicine. I have past experience in retrospective and prospective outcome based research studies in the Sports Medicine and Orthopedics fields. I will be working with board certified musculoskeletal radiologist, Dr. Steven Herwick, and board certified podiatric surgeon, Dr. Adam Fleischer.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.