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Can bone quality be predicted accurately by Singh index in patients with rheumatoid arthritis?

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Abstract

The aim of this study was to evaluate Singh index as a simple and inexpensive means of estimation of bone quality in patients with rheumatoid arthritis. Singh index evaluation was made on digital pelvis radiographs in 50 consecutive patients by three observers. Bone mineral density T scores of the spine and left proximal femur were assessed using dual energy X-ray absorptiometry. Singh index was correlated with densitometry measurements after grouping the patients as normal, osteopenia and osteoporosis. Intra- and interobserver agreements were evaluated by kappa correlations. Sensitivity, specificity, positive and negative predictive values and likelihood ratio’s of Singh index were calculated. Both intra- and interobserver agreements were 0.71 (range, 0.69 to 0.72) on average. Singh index proved highly sensitive for the diagnosis of osteopenia at the proximal femur (91%) and spine (90%), whereas the specificity of Singh index for identifying of osteoporosis at the femoral neck (93%) and spine (91%) was higher than sensitivity. Predictive values for osteoporosis at the proximal femur and spine were acceptable and positive likelihood ratios of Singh index for osteopenia and osteoporosis at the proximal femur were 2.4 and 10.1, respectively. Singh index can identify osteoporosis with a high specificity in patients with rheumatoid arthritis. However, the patients who are graded as osteopenia by the Singh index should undergo further evaluation with dual energy X-ray absorptiometry.

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Acknowledgments

We thank the patients who participated in this study and Rana Konyalıoglu (statistician) for contributing to the statistical analysis.

Disclosures

None.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine, Rheumatology, Abant Izzet Baysal University, Bolu, Turkey

    Cemal Bes & Mehmet Soy

  2. Faculty of Medicine, Department of Orthopaedics and Traumatology, Yeditepe University, Istanbul, Turkey

    Melih Güven

  3. Orthopaedics and Traumatology Clinic, Artvin Government Hospital, Artvin, Turkey

    Budak Akman

  4. Orthopaedics and Traumatology Clinic, Rumeli Hospital, Sefaköy, Istanbul, Turkey

    Evren Fehmi Atay

  5. Faculty of Medicine, Department of Orthopaedics and Traumatology, Abant Izzet Baysal University, Bolu, Turkey

    Emrah Ceviz

Authors
  1. Cemal Bes
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  2. Melih Güven
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  3. Budak Akman
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  4. Evren Fehmi Atay
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  5. Emrah Ceviz
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  6. Mehmet Soy
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Correspondence to Melih Güven.

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Bes, C., Güven, M., Akman, B. et al. Can bone quality be predicted accurately by Singh index in patients with rheumatoid arthritis?. Clin Rheumatol 31, 85–89 (2012). https://doi.org/10.1007/s10067-011-1786-2

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  • DOI: https://doi.org/10.1007/s10067-011-1786-2

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