Skip to main content
SpringerLink
Log in

Evaluation of the Singh index and femur geometry in osteoporotic women

  • Research Article
  • Published:
Central European Journal of Medicine

Abstract

We aimed to compare the Singh index with bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), body mass index (BMI) and femur geometry in the right proximal femur of osteoporotic women, using different statistical tests. Radiographs of each patient were assessed to determine the Singh index by five observers. The observers consisted of a consultant radiologist, physical therapist and anatomists who studied the series of radiographs. They were asked to apply the Singh index by comparing the trabecular bone pattern in the proximal right femur with the reference scale published by Singh et al. [1]. This has a six point scale from grade VI to grade I. We evaluated 47 osteoporotic women in this study. The subjects’ mean age, weigth, and height were 63,21 ± 10,106, 66,72 ± 12.523, 154,94 ± 7,026 respectively. We found a significant relationship between the Singh index and BMD. The Singh index correlated significantly with hip axis length, femoral neck diamater and trochanteric width. And, BMD correlated significantly with femoral head and neck diameter, femoral neck cortex width, medial calcar femoral cortex width and femoral shaft cortex width. The evaluation of the Singh index grades in its self, there was a significant relation among them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Singh M., Nagrath A.R., Maini P.S, Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J. Bone Joint Surg., 1970, 52, 457–67

    PubMed  CAS  Google Scholar 

  2. Pramudito J.T., Soegijoko S., Mengko T.R., Muchtadi F.I., Wachjudi R.G., Trabecular Pattern Analysis of Proximal Femur Radiographs for Osteoporosis Detection. Journal of Biomedical & Pharmaceutical Engineering, 2007, 1, 45–51

    Google Scholar 

  3. Melton L.J., “Epidemiology worldwide”. Endocrinol. Metab. Clin. North Am., 2003, 32,1–13

    Article  PubMed  Google Scholar 

  4. Raisz L., “Pathogenesis of osteoporosis: concepts, conflicts, and prospects.”. J. Clin. Invest., 2005, 115, 3318–3325

    Article  PubMed  CAS  Google Scholar 

  5. Ojo F., Al Snih S., Ray L.A., Raji M.A., Markides K.S., “History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans”. J. Natl. Med. Assoc., 2007, 99, 412–418

    PubMed  Google Scholar 

  6. Shapses S.A., Riedt C.S., “Bone, body weight, and weight reduction: what are the concerns?”. J. Nutr., 2006, 136, 1453–1456

    PubMed  CAS  Google Scholar 

  7. Riggs B.L., Melton L.J., The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone, 1995, 17(Supplement 1), S505–S511

    Article  Google Scholar 

  8. WHO, “Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group”. World Health Organization technical report series, 1994, 843, 1–129

    Google Scholar 

  9. Harty, M., 1957. The Calcar Femorale and the Femoral Neck. J. Bone Joint Surg. Am. 39, 625–630

    PubMed  Google Scholar 

  10. Kawashima T., Uhthoff H.K., Pattern of bone loss of the proximal femur: a radiologic, densitometric, and histomorphometric study. J. Orthop. Res., 1991, 9, 634–640

    Article  PubMed  CAS  Google Scholar 

  11. Koot V.C., Kesselaer S.M., Clevers G.J., de Hooge P., Weits T., van der Werken C., Evaluation of the singh index for measuring osteoporosis. J. Bone Joint Surg. Br., 1996, 78, 831–834

    PubMed  CAS  Google Scholar 

  12. Masud T., Jawed S., Doyle D.V., Spector T.D., A population study of the screening potential of assessment of trabecular pattern of the femoral neck (singh index): the chingford study. Br. J. Radiol., 1995, 68, 389–893

    Article  PubMed  CAS  Google Scholar 

  13. Pogrund H., Rigal W.M., Makin M., Robin G., Menczel J., Steinberg R., Determination of osteoporosis in patients with fractured femoral neck using the singh index: a jerusalem study. Clin. Orthop., 1981, 156, 189–195

    PubMed  Google Scholar 

  14. Smyth P.P., Adams J.E., Whitehouse R.W., Taylor C.J., Application of computer texture analysis to the singh index. Br. J. Radiol., 1997, 70, 242–247

    PubMed  CAS  Google Scholar 

  15. Bindeus T., Vrba S., Gabler C., Rand T., Stanek C., Comparison of computed radiography and conventional film-screen radiography of the equine stifle. Vet. Radiol. Ultrasound., 2002, 43, 455–460

    Article  PubMed  Google Scholar 

  16. Okamura T., Tanaka S., Koyama K., Norihumi N., Daikokuya H., Matsuoka T., Kishimoto K., Hatagawa M., Kudoh H., Yamada R., Clinical evaluation of digital radiography based on a largearea cesium iodide-amorphous silicon flat panel detector compared with sceen-film radiography for skeletal system and abdomen. Eur. Radiol., 2002, 12, 1741–1747

    Article  PubMed  Google Scholar 

  17. Redlich U., Hoeschen C., Effenberger O., Fessel A., Preuss H., Reissberg S., Scherlach C., Döhring W., Comparison of four digital and one conventional radiographic image systems for the chest in a patient study with subsequent system optimization. Rofo, 2005, 177, 272–278

    PubMed  CAS  Google Scholar 

  18. Wagner S., Stäbler A., Sittek H., Bonel H., Laeverenz G., Reiser M.F., Baur-Melnyk A., Diagnosis of osteoporosis: visual assessment on conventional and digital radiographs. Osteoporos. Int., 2005, 16,1815–1822

    Article  PubMed  Google Scholar 

  19. Wu C., van Kuijk C., Li J., Jiang Y., Chan M., Countryman P., Genant H.K., Comparison of digitized images with original radiography for semiquantitative assessment of osteoporotic fractures. Osteoporos. Int., 2000, 11, 25–30

    Article  PubMed  Google Scholar 

  20. Gregory J.S, Aspden R.M., Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med. Eng. Phys., 2008, 30, 1275–1286

    Article  PubMed  Google Scholar 

  21. Partanen J., Jamsa T., Jalovaara P., Influence of the upper femur and pelvic geometry on the risk and type of hip fractures. J. Bone Miner. Res., 2001, 16, 1540–1546

    Article  PubMed  CAS  Google Scholar 

  22. Sah A.P., Thornhill T.S., Leboff M.S., Glowacki J., Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporos. Int., 2007, 18, 1119–1126

    Article  PubMed  CAS  Google Scholar 

  23. Faulkner K.G., Wacker W.K., Barden H.S., Simonelli C., Burke P.K., Ragi S., Del Rio L., Femur strength index predicts hip fracture independent of bone density and hip axis length. Osteoporos. Int., 2006, 17, 593–599

    Article  PubMed  CAS  Google Scholar 

  24. Wilkin T.J., Devendra D., 2001. Bone densitometry is not a good predictor of hip fracture. BMJ., 2001, 323, 795–797

    Article  PubMed  CAS  Google Scholar 

  25. Kanis J.A., Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002, 359, 1929–1936

    Article  PubMed  Google Scholar 

  26. Stone K.L., Seeley D.G., Lui L.Y., Cauley J.A., Ensrud K., Browner W.S., Nevitt M.C., Cummings S.R., & Osteoporotic Fractures Research Group, BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J. Bone Miner. Res., 2003, 18, 1947–1954

    Article  PubMed  Google Scholar 

  27. Schuit S.C., van der Klift M., Weel A.E., de Laet C.E., Burger H., Seeman E., Hofman A., Uitterlinden A.G., van Leeuwen J.P., Pols H.A., Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone, 2004, 34, 195–202

    Article  PubMed  CAS  Google Scholar 

  28. Glüer C.C., Cummings S.R., Pressman A., Li J., Glüer K., Faulkner K.G., Grampp S., Genant H.K., Prediction of hip fractures from pelvic radiographs: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. J. Bone Miner. Res., 1994, 9, 671–677

    Article  PubMed  Google Scholar 

  29. Merrill V, Atlas of roentgenographic positions and standard radiologic procedures. The C.V. Mosby Company; 1975

  30. Cheng X.G., Nicholson P.H., Bonen S., Brys P., Lowet G., Nijs J., Dequeker J., Effects of anteversion on femoral bone mineral density and geometry measured by dual energy X-ray absorptiometry: a cadaver study. Bone, 1997, 21, 113–117

    Article  PubMed  CAS  Google Scholar 

  31. Karlsson K.M., Sernbo I., Obrant K.J., Redlund-Johnell I., Johnell O., Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture. Bone, 1996, 18, 327–330

    Article  PubMed  CAS  Google Scholar 

  32. Krischak G.D., Augat P., Wachter N.J., Kinzl L., Claes L.E., Predictive value of bone mineral density and Singh Index for the in vitro mechanical properties of cancellous bone in the femoral head. Clin. Biomech., 1999, 14, 346–351

    Article  CAS  Google Scholar 

  33. D’Amelio P., Rossi P., Isaia G., Lollino N., Castoldi F., Girardo M., Dettoni F., Sattin F., Delise M., Bignardi C., Bone mineral density and singh index predict bone mechanical properties of human femur. Connect Tissue Res., 2008, 49, 99–104

    Article  PubMed  Google Scholar 

  34. Pulkkinen P., Jämsä T., Lochmüller E.M., Kuhn V., Nieminen M.T., Eckstein F., Experimental hip fracture load can be predicted from plain radiography by combined analysis of trabecular bone structure and bone geometry. Osteoporos. Int., 2008, 19, 547–558

    Article  PubMed  CAS  Google Scholar 

  35. Hauschild O., Ghanem N., Oberst M., Baumann T., Kreuz P.C., Langer M., Suedkamp N.P., Niemeyer P., Evaluation of Singh index for assessment of osteoporosis using digital radiography. (Article in press) doi:10.1016/j.ejrad.2008.03.019.

  36. Faulkner K.G., Cummings S.R., Black D., Palermo L., Glüer C.C., Genant H.K., Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J. Bone Miner. Res., 1993, 8, 1211–1217

    Article  PubMed  CAS  Google Scholar 

  37. Faulkner K.G., McClung M., Cummings S.R., Automated evaluation of hip axis length for predicting hip fracture. J. Bone Miner. Res., 1994, 9, 1065–1070

    Article  PubMed  CAS  Google Scholar 

  38. Gnudi S., Ripamonti C., Lisi L., Fini M., Giardino R., Giavaresi G., Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos. Int., 2002, 13, 69–73

    Article  PubMed  CAS  Google Scholar 

  39. Bonen S., Koutri R., Dequeker J., Aerssens J., Lowet G., Nijs J., Verbeke G., Lesaffre E., Geusens P., Measurement of femoral geometry in Type-I and Type-II osteoporosis—differences in hip axis length consistent with heterogeneity in the pathogenesis of osteoporotic fractures. J. Bone Miner. Res., 1995, 10, 1908–1912

    Article  Google Scholar 

  40. Gnudi S., Ripamonti C., Gualtieri G., Malavolta N., Geometry of proximal femur in the prediction of hip fracture in osteoporotic women. Br. J. Radiol., 1999, 72, 729–733

    PubMed  CAS  Google Scholar 

  41. Frisoli A., Paula A.P., Pinheiro M., Szejnfeld V.L., Piovezan R.D., Takata E., Silva T.A., Chaves P.H.M., Hip axis length as an independent risk factor for hip fracture independently of femural bone mineral density in Caucasian elderly Brazilian women. Bone, 2005, 37, 871–875

    Article  PubMed  Google Scholar 

  42. Bergot C., Bousson V., Meunier A., Laval-Jeantet M., Laredo, J.D., Hip fracture risk and proximal femur geometry from DXA scans. Osteoporos. Int., 2002, 13, 542–550

    Article  PubMed  CAS  Google Scholar 

  43. Duboeuf F., Hans D., Schott A.M., Kotzki P.O., Favier F., Marcelli C., Meunier P.J., Delmas P.D., Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS study. J. Bone Miner. Res., 1997, 12, 1895–1902

    Article  PubMed  CAS  Google Scholar 

  44. Alonso C.G., Diaz M.D., Carranza F.H., Cano R.P., Perez A.D., Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Osteoporos. Int., 2000, 11, 714–720

    Article  PubMed  CAS  Google Scholar 

  45. Pande, I., O’Neill T.W., Pritchard C., Scott D.L., Woolf A.D., Bone mineral density, hip axis length and risk of hip fracture in men: results from the Cornwall hip fracture study. Osteoporos. Int., 2000, 11, 866–870

    Article  PubMed  CAS  Google Scholar 

  46. Kukla C., Gaebler C., Pichl R.W., Prokesch R., Heinze G., Heinz T., Predictive geometric factors in a standardized model of femoral neck fracture: experimental study of cadaveric human femurs. Injury, 2002, 33, 427–433

    Article  PubMed  CAS  Google Scholar 

  47. Le Bras A., Kotla S., Soubrane P., Skalli W., Roux C., Mitton D., Assessment of femoral neck strength by 3-dimensional X-ray absorptiometry. J. Clin. Densitom., 2006, 9, 425–430

    Article  PubMed  Google Scholar 

  48. Cummings S.R., Black D.M., Nevitt M.C., Browner W., Cauley J., Ensrud K., Genant H.K., Palermo L., Scott J., Vogt T.M., Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet, 1993, 341, 72–75

    Article  PubMed  CAS  Google Scholar 

  49. Marshall D., Johnell O., Wedel H., Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ., 1996, 312, 1254–1259

    PubMed  CAS  Google Scholar 

  50. Schott A.M., Cormier C., Hans D., Favier F., Hausherr E., Dargent-Molina P., Delmas P.D., Ribot C., Sebert J.L., Breart G., Meunier P.J., How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporos. Int., 1998, 8, 247–254

    Article  PubMed  CAS  Google Scholar 

  51. Johnell O., Kanis J.A., Oden A., Johansson H., De Laet C., Delmas P., Eisman J.A., Fujiwara S., Kroger H., Mellstrom D., Meunier P.J., Melton L.J. 3rd, O’Neill T., Pols H., Reeve J., Silman A., Tenenhouse A., Predictive value of BMD for hip and other fractures. J. Bone Miner. Res., 2005, 20, 1185–1194

    Article  PubMed  Google Scholar 

  52. Rivadeneira F., Zillikens M.C., De Laet C.E., Hofman A., Uitterlinden A.G., Beck T.J., Pols H.A., Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J. Bone Miner. Res., 2007, 22, 1781–1790

    Article  PubMed  Google Scholar 

  53. Michelotti J., Clark J., Femoral neck length and hip fracture risk. J Bone Miner Res., 1999, 14, 1714–1720

    Article  PubMed  CAS  Google Scholar 

  54. Anderson J.Y., Trinkaus E., Patterns of sexual, bilateral and interpopulational variation in human femoral neck-shaft angles. J. Anat., 1998, 192, 279–285

    Article  PubMed  Google Scholar 

  55. Cheng X.G., Lowet G., Bonen S., Nicholson P.H., Brys P., Nijs J., Dequeker J., 1997b. Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone, 1997, 20, 213–218

    Article  PubMed  CAS  Google Scholar 

  56. Pulkkinen P., Eckstein F., Lochmüller E.M., Kuhn V., Jämsä T., Association of geometric factors and failure load level with the distribution of cervical vs. trochanteric hip fractures. J. Bone Miner. Res., 2006, 21, 895–901

    Article  PubMed  Google Scholar 

  57. Dibba B., Prentice A., Laskey M.A., Stirling D.M., Cole T.J., An investigation of ethnic differences in bone mineral, hip axis length, calcium metabolism and bone turnover between West African and Caucasian adults living in the United Kingdom. Ann. Hum. Biol., 1999, 26, 229–242

    Article  PubMed  CAS  Google Scholar 

  58. Barondess D.A., Singh M., Hendrix S.L., Nelson D.A., Radiographic Measurements, Bone Mineral Density, and the Singh index in the Proximal Femur of White and Black Postmenopausal Women. Dis. Mon., 2002, 48, 637–646

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey

    Özlen Karabulut, Mehmet Cudi Tuncer & Eyüp Savaş Hatipoğlu

  2. Department of Physical Medicine, Özel Veni Vidi Hospital, 21100, Diyarbakır, Turkey

    Zülfü Karabulut

  3. Department of Radiology, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey

    Hasan Nazaroğlu

  4. Department of Biostatistics, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey

    Zeki Akkuş

Authors
  1. Özlen Karabulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Cudi Tuncer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zülfü Karabulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eyüp Savaş Hatipoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hasan Nazaroğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeki Akkuş
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Cudi Tuncer.

About this article

Cite this article

Karabulut, Ö., Tuncer, M.C., Karabulut, Z. et al. Evaluation of the Singh index and femur geometry in osteoporotic women. cent.eur.j.med 5, 601–610 (2010). https://doi.org/10.2478/s11536-009-0136-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-009-0136-0

Keywords

Search

Navigation