Radiographic Absorptiometry as a Screening Tool in Male Osteoporosis: Results from the Odense Androgen Study

Background: Osteoporosis screening with dual-energy absorptiometry (DXA) is not recommended due to low diagnostic utility and costs. Radiographic absorptiometry (RA) determines bone mineral density (BMD) of the phalangeal bones of the hand and is a potential osteoporosis pre-screening tool. Purpose: To determine the ability of RA to identify patients with osteoporosis in a male population. Material and Methods: As part of the Odense Androgen Study, we measured BMD of the intermediate phalanges of the second to fourth finger, lumbar spine (L2-L4), and total hip in 218 men aged 60-74 years (mean 68.8 years), randomly invited from the population, using RA (MetriScan) and DXA (Hologic 4500-A). Osteopenia and osteoporosis were defined as a T-score of less than -1.0 and -2.5, respectively, in the hip and/or lumbar spine. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were computed. Results: BMD(RA) of the phalanges correlated significantly with BMD(DXA) of the hip (R=0.47, P<0.001) and lumbar spine (R=0.46, P<0.001). A total of 105 men (48.2%) were osteopenic and 15 (6.9%) osteoporotic. The AUC (SE) value for detecting osteoporosis was 0.75 (0.06). The sensitivity and specificity of RA in identifying osteoporosis were 0.93 and 0.50, respectively. Conclusion: BMD(RA) correlated weakly with BMD(DXA) of the lumbar spine and total hip, and RA has a moderate ability to identify osteoporotic individuals. Nevertheless, RA may be used as a pre-screening tool in men, since the diagnosis may be ruled out in half the population at little cost.