Association of the presence of bone bars on radiographs and low bone mineral density
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Bone bars (BB) are struts of normal trabecular bone that cross the medullary portions of the metaphysis and diaphysis at right angles to the long axis of the shaft. The purpose of this investigation was to determine whether the presence of bone bars (BB) identified on radiographs of the proximal femurs and tibia, predict lower bone mineral density (BMD) as evaluated with dual-energy x-ray absorptiometry (DXA) in the lumbar spine, total hip, or femoral neck.
Materials and methods
A total of 134 sequential DXA patients underwent radiography of the pelvis, hips, and both knees. The radiographs were evaluated for the presence of BB by two musculoskeletal radiologists who were blinded to DXA results. A t test was used to evaluate the relationship of BB to BMD and a Chi-square test was used to determine if BB were equally distributed among the categories of normal BMD, low bone mass (osteopenia), and osteoporosis.
BB were associated with lower BMD at all measured sites. BB at the intertrochanteric and proximal tibial sites were the most predictive of low BMD while supraacetabular and distal femur BB were less predictive. Osteoporosis or osteopenia is seen in 60–91% of those with BB depending on the side and reader. It is only seen in about 40% of those without BB.
We conclude that the presence of BB suggest decreased BMD and when correlated with other clinical information, might support further evaluation of BMD.
KeywordsBone bars Dual-energy x-ray absorptiometry Bone mineral density
This study was supported by an unrestricted educational grant from Procter & Gamble.
- 1.Pitt M. Osteopenic bone diseases. Orthop Clin N Am. 1983;14:65–80.Google Scholar
- 2.Krusunoglu S, Pate D, Resnick D, Haghgigh P, Tyson R, Pitt M. Bone reinforcement lines in chronic adult osteopenia: A hypothesis. Radiology. 1986;158:409–15.Google Scholar
- 3.National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC. National Osteoporosis Foundation, 2008.Google Scholar
- 4.World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO technical report series 843. Geneva: World Health Organization; 1994.Google Scholar
- 6.Garn SM, Silverman FN, Hertzog KP, Rohmann CG. Lines and bands of increased density. Their implications to growth and development. Med Radiogr Photogr. 1968;44:409–415.Google Scholar
- 7.Johnston CC, Epstein S. Clinical, biochemical, radiographic, epidemiologic and economic factors of osteoporosis. Orthop Clin N Am. 1981;12:559–69.Google Scholar