The relationship between the 2nd metacarpal index and bone mineral density for osteopenia/osteoporosis screening: a systematic review

Bone Health Index (BHI): a Fracture Risk Assessment tool in Children with Osteogenesis Imperfecta.

The study indicates that lower BHI SDS values are associated with increased fracture risk in children with classical OI and indicates that BHI may represent a clinically useful complementary tool for fracture risk stratification in young children with OI, particularly where DXA is unavailable or technically limited, including infancy.

Radiographic Indices for Osteoporosis Screening Using CTI and CCR in Resource-Limited Settings: A Literature Review

Osteoporosis reduces bone integrity, significantly increasing the risk of fractures. This study aims to identify alternative screening methods for assessing osteoporosis in low-income settings, where access to dual-energy X-ray absorptiometry (DXA) is limited. A literature review was conducted, analyzing articles from Google Scholar, PubMed, and institutional libraries published between 2015 and 2025, to identify auxiliary methods for screening for osteoporosis when DXA is not available. Conventional radiographs, when analyzed through the assessment of the Cortical Thickness Index (CTI) and the Calcar-Canal Ratio (CCR), demonstrated high sensitivity and specificity as auxiliary screening tools. However, cutoff values vary significantly among different ethnic populations, indicating the absence of a universal diagnostic standard and underscoring the need for population-specific thresholds. Limited access to DXA worldwide delays early detection of osteoporosis and increases the risk of fragility fractures. Further studies are needed to standardize these metrics in Mexico, which would enable timely diagnosis and treatment in resource-limited settings, thereby improving patient outcomes and quality of life.

Cortical Indices, DXA, and FRAX as Indicators of Bone Fragility: A Comparative Human Cadaveric Study

Osteoporosis is a progressive skeletal disorder characterized by reduced bone mineral density (BMD) and increased risk of fragility fractures. Clinical assessment relies primarily on dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool (FRAX), but limited access and low screening rates motivate investigation of complementary approaches. This human cadaveric study evaluated cortical indices of the second metacarpal, radius, and femur in relation to DXA-based osteoporosis status and biomechanically derived fracture susceptibility at the wrist and hip. Cortical measurements were obtained from 39 donor-matched forearms and femurs categorized as normal (n = 8), osteopenic (n = 11), and osteoporotic (n = 20) based on femoral neck DXA T-score. Simulated fall testing of the distal radius and proximal femur was performed to determine work to fracture, which was used to derive low and high biomechanical fracture susceptibility classifications. Among the cortical indices, metacarpal cortical index (MCI) demonstrated the strongest associations with DXA T-scores and biomechanical outcomes. MCI distinguished normal from osteoporotic classification at the femoral neck (area under the curve (AUC) = 0.938) and 1/3 radius (AUC = 0.986). For biomechanically derived fracture susceptibility, femoral neck T-score demonstrated strong discrimination at both the femur (AUC = 0.917) and wrist (AUC = 0.851), while MCI yielded AUCs of 0.847 and 0.855, respectively. FRAX hip fracture (HF) probability yielded AUCs of 0.911 at the femur and 0.830 at the wrist. These findings demonstrate associations between MCI, DXA-based osteoporosis status, and biomechanical fracture susceptibility in this cadaveric cohort. MCI may therefore warrant further investigation as a complementary screening approach, particularly where access to DXA is limited. Validation in larger clinical cohorts with prospective fracture outcomes is needed to determine its clinical utility.

Clinical integration of trabecular bone score in precision osteoporosis care: a position statement by the Egyptian academy of bone and muscle health

An up-to-date review of the evidence base, which informs the implementation of Trabecular Bone Score (TBS) in clinical practice, and explores the paradigm shift toward a dual Quantity+Quality model in bone health assessment, centred on the TBS.

Screening for Low Bone Mineral Density Using Opportunistic Foot Radiographs.

BACKGROUND The gold standard for low bone mineral density (BMD) screening is dual-energy X-ray absorptiometry (DXA) scanning, which has declined in use in recent years for a variety of reasons. This decline warrants alternative screening mechanisms. This study aimed to determine if opportunistic foot radiographs can serve as a screening tool for predicting low BMD as measured by DXA scan. METHODS The fifth metatarsal index (5MI), a novel measurement made using the oblique foot radiograph to evaluate cortical thickness, was calculated for patients 50 years and older who underwent a DXA scan and a foot radiograph within 1 year. T scores and BMD were documented for each patient. Receiver operating characteristic curves were generated, and areas under the curves were calculated to determine which 5MI had optimized sensitivity and specificity for identifying osteoporosis. RESULTS A total of 89 patients were included in the study cohort. The average 5MI in patients with normal BMD, osteopenia, and osteoporosis was 52.6%, 44.6%, and 35.2%, respectively. The optimal 5MI for identifying osteoporosis based on the DXA-derived T scores was 46.8%, which correlated with an area under the curve of 0.977. This optimal cutoff for identifying osteoporosis had a sensitivity of 93.3% (95% CI, 70.2%-99.7%) and a specificity of 95.0% (95% CI, 76.4%-99.7%) (P < .001). CONCLUSION This study describes a potential screening method using low-cost foot radiographs to identify patients with low BMD, which may support earlier detection and referral for bone health evaluation. LEVEL OF EVIDENCE Level III, retrospective case series.

Nails in osteoporosis and bone metabolism: a narrative review of current evidence and future directions