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Low Bone Mass and Fractures on Foot Radiographs: Missed Opportunities to Evaluate for Osteoporosis

A Pilot Study

Marisha T. Newton, MD ^*, Juanita A. Archer, MD ^*, Michangelo Scruggs, DPM , Kirk Geter, DPM , Hiba Al-Dabagh, MBBS ^*, Errol Lloyd, MD  and Maria Nwokike, MD ^*

^* Division of Endocrinology, Department of Internal Medicine, Howard University, College of Medicine, Washington, DC.
Department of Podiatry, Howard University Hospital, Washington, DC.
Department of Radiology, Howard University Hospital, Washington, DC.

Corresponding author: Juanita A. Archer, MD, Division of Endocrinology, Department of Internal Medicine, Howard University, College of Medicine, 2041 Georgia Ave, NW, Washington, DC 20060. (E-mail: jjaharcher{at}aol.com)

Abstract

Background: Osteoporosis is often unrecognized, even in the presence of radiologic evidence of vertebral or nonvertebral fragility fractures.

Methods: Ninety patients aged 50 years and older with radiographs of the foot taken at Howard University Hospital between 2003 and 2005 were randomly selected. In phase 1, standard radiograph reports were reviewed for evidence of osteopenia, fractures, or both. In phase 2, risk factors for osteoporosis and dual energy x-ray absorptiometry scans were obtained.

Results: In phase 1, radiologists reported all of the fractures for all 90 participants; however, osteopenia was reported in only 54.7% of these. In phase 2, for 50% of the participants with radiographic evidence of osteopenia, fractures, or both, there was no evidence that the clinicians evaluated risk factors for low bone mass or requested a dual energy x-ray absorptiometry scan. Of participants who had radiographic evidence of osteopenia, osteoporosis, or both, 83.3% met the criteria for dual energy x-ray absorptiometry scans.

Conclusions: Osteopenia or fracture observed on radiographs of the foot are predictive of low bone mass but are often not evaluated. (J Am Podiatr Med Assoc 99(1): 1–7, 2009)