Diagnostic Value of Radiographic Singh Index Compared to Dual-Energy X-Ray Absorptiometry Scan in Diagnosing Osteoporosis: A Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors

1 Mashhad Medical School, Mashhad University of Medical Science, Mashhad, Iran

2 Rheumatic Disease Research Center, Mashhad University of Medical Science Mashhad, Iran

3 Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Objectives: Since various medications can control the rate of fractures and subsequent complications 
of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare 
the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a 
benchmark standard for diagnosing osteoporosis.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the 
current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. 
Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 
(QUADAS-2).
Results: A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for 
detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of 
SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was 
reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to 
DEXA (n=13), six studies estimated a low sensitivity for SI.
Conclusion: While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck 
fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value 
as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the 
effectiveness of the SI index in identifying populations at risk of osteoporosis.
 Level of evidence: V

Keywords

Main Subjects

References

  1. Wright N, Saag K, Dawson-Hughes B, Khosla S, Siris E. The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA. Osteop Int. 2017; 28(4):1225-32. doi: 10.1007/s00198-016-3865-3. .
  2. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low 

    bone mass in older adults: United States; 2021.

    1. Tu KN, Lie JD, Wan CK, et al. Osteoporosis: a review of treatment options. Pharm Therap. 2018; 43(2):92.
    2. Akkawi I, Zmerly H. Osteoporosis: current concepts. Joints. 2018; 6(2):122-7. doi: 10.1055/s-0038-1660790
    3. Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Therapeutics and clinical risk management. 2018; 14:2029. doi: 10.2147/TCRM.S138000
    4. Bover J, Ureña-Torres P, Torregrosa JV, et al. Osteoporosis, bone mineral density and CKD–MBD complex (I): Diagnostic considerations. Nefrología (English Edition). 2018; 38(5):476-90. doi: 10.1016/j.nefro.2017.12.006
    5. Bover J, Ureña-Torres P, Laiz Alonso AM, et al. Osteoporosis, bone mineral density and CKD-MBD (II): therapeutic implications. Nefrología (English Edition). 2019; 39(3):227-42. doi: 10.1016/j.nefro.2018.10.009
    6. de Wit M, Cooper C, Tugwell P, et al. Practical guidance for engaging patients in health research, treatment guidelines and regulatory processes: results of an expert group meeting organized by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res. 2019; 31(7):905-15. doi: 10.1007/s40520-019-01193-8.
    7. Marques A, Lourenço Ó, Da Silva J. The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality. Osteoporos Int. 2015; 26(11):2623-30. doi: 10.1007/s00198-015-3171-5
    8. Salamat M, Rostampour N, Shanehsazzadeh S, Tavakoli M, Siavash M, Almasi T. Assessment of bone mineral density with dual energy X-ray absorptiometry in pre-and post-menopausal women. Iran J Radiat Res. 2008; 6(2):103-7.
    9. Punda M, Grazio S. Bone densitometry–the gold standard for diagnosis of osteoporosis. Reumatizam. 2014; 61(2):70-4.
    10. Messina C, Monaco CG, Ulivieri FM, Sardanelli F, Sconfienza LM. Dual-energy X-ray absorptiometry body composition in patients with secondary osteoporosis. Eur J Radiol. 2016; 85(8):1493-8. doi: 10.1016/j.ejrad.2016.03.018
    11. Julka A, Shrivastava S, Pandey R, Bhargav P, Ajmera A. To evaluate the utility of Singh index as an indicator of osteoporosis and a predictor of fracture neck femur. J Anatom Soc India. 2012; 61(2):192-8. doi: 10.1016/S0003-2778(12)80031-1
    12. Koot V, Kesselaer S, Clevers GJ, De Hooge P, Weits T, van der Werken C. Evaluation of the Singh index for measuring osteoporosis. J Bone Joint Surg Br. 1996; 78(5):831-4. PMID: 8836082
    13. Soontrapa S, Soontrapa S, Srinakarin J, Chowchuen P. Singh index screening for femoral neck osteoporosis. J Med Assoc Thailand. 2005; 88:S13. PMID: 16869101
    14. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019; 10:ED000142. doi: 10.1002/14651858.ED000142
    15. Hübsch P, Kocanda H, Youssefzadeh S, et al. Comparison of dual energy X-ray absorptiometry of the proximal femur with morphologic data. Acta Radiologica. 1992; 33(5):477-81.
    16. Salamat M, Rostampour N, Zoufaghari SJ, Hosseinipanah H, Javdan M. Comparison of Singh index accuracy and dual energy X-ray absorptiometry bone mineral density measurement for evaluating osteoporosis. Iran J Radiat Res. 2010; 8(2):123-8.
    17. Chung CY, Son YC, Bae JB, Park BJ. Evaluation of the Singh index for measurement of osteoporosis. J Korean Orthop Assoc. 1999; 34(5):871-5. PMID: 8836082
    18. Kapishnikov A, Pervushkin S, Gaidel A, Alekhin E. Efficient textural features selection for computer-aided diagnosis (CAD) of osteoporosis by plain hip radiography. European Congress of Radiology-ECR 2013; 2013: C-1358. doi: 10.1594/ecr2013/C-1358
    19. Mir FR, Nazir I, Naseed M. Comparison of radiographic singh index with dual-energy x-ray absorptiometry scan in diagnosing osteoporosis. Matrix Science Medica. 2021; 5(1):17. doi: 10.4103/MTSM.MTSM_41_20
    20. Liu Z, Gao H, Bai X, Zhao L, Li Y, Wang B. Evaluation of Singh Index and Osteoporosis Self-Assessment Tool for Asians as risk assessment tools of hip fracture in patients with type 2 diabetes mellitus. J Orthop Surgery Res. 2017; 12(1):1-7.
    21. Qadir RI, Bukhari SI. Singh’s index accuracy with DEXA scan for evaluation of osteoporosis. J Med Sci. 2016; 24(1):12-5.
    22. Shankar N, Vijay A, Ligesh AS, Kumar A, Anburajan M. Comparison of Singh's index with Dual energy x-ray absorptiometry (DXA) in evaluating post-menopausal osteoporosis. IEEE. 2011; 1:361-4. doi: 10.1109/ICECTECH.2011.5941772
    23. Karabulut Ö, Tuncer M, Karabulut Z, Hatipoğlu E, Nazaroğlu H, Akkuş Z. Evaluation of the Singh index and femur geometry in osteoporotic women. Open Med. 2010; 5(5):601-10. doi: 10.2478/s11536-009-0136-0
    24. Memon MA, Sohail S, Ahmed A. Radiographic morphometry of the osteoporotic femur: Comparison with densitometry. J Surg Pak. 2007; 12(4):144.
    25. Sah AP, Thornhill TS, LeBoff MS, Glowacki J. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteop Int. 2007; 18(8):1119-26. doi: 10.1007/s00198-007-0348-6
    26. Trijoto I, Isbagio H, Setiyohadi B, Soegondo S, Kusumawidjaja K, Ariawan I. The diagnostic value of combined risk factor analysis and radiological imaging in determining osteoporosis in post-menopausal women. Acta Med Indones. 2005; 37(1):26-32. PMID: 15879634
    27. Anburajan M. Evaluation of osteoporosis using conventional radiographic methods and dual energy x‐ray absorptiometry. Med Physics. 2001; 28(6):1142-2. doi: 10.1118/1.1376643
    28. Alexa O, Puha B, Alexa ID, Gheorghevici TS, Filip A, Veliceasa B. Is the Singh Index useful for evaluating osteoporosis? IEEE. 2017; 1:205-8. doi: 10.1109/EHB.2017.7995397
    29. Klatte T, Vettorazzi E, Beckmann J, Pueschel K, Amling M, Gebauer M. The Singh Index does not correlate with bone mineral density (BMD) measured with dual energy X-ray absorptiometry (DXA) or peripheral quantitative computed tomography (pQCT). Arch Orthop Trauma Surg. 2015; 135(5):645-50. doi: 10.1007/s00402-015-2187-9
    32.              Masud T, Jawed S, Doyle D, Spector T. 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(808):389-93. doi: 10.1259/0007-1285-68-808-389 

    1. Karlsson KM, Sernbo I, Obrant KJ, Redlund-Johnell I, Johnell O. Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture. Bone. 1996; 18(4):327-30. doi: 10.1016/8756-3282(96)00004-x
    2. Burli U, Patil KS, Chamakeri PH, Mittal AR. Reliability of radiological indices in comparison with dual energy x-ray absorptiometry in diagnosis of osteoporosis: A cross-sectional study. Int J Orthop. 2020; 6(3):643-6. doi: 10.22271/ortho.2020.v6.i3j.2265
    3. Hauschild O, Ghanem N, Oberst M, et al. Evaluation of Singh index for assessment of osteoporosis using digital radiography. Eur J Radiol. 2009; 71(1):152-8. doi: 10.1016/j.ejrad.2008.03.019
    4. Bes C, Güven M, Akman B, Atay EF, Ceviz E, Soy M. Can bone quality be predicted accurately by Singh index in patients with rheumatoid arthritis? Clin Rheumatol. 2012; 31(1):85-9. doi: 10.1007/s10067-011-1786-2
    5. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002; 359(9321):1929-36. doi: 10.1016/S0140-6736(02)08761-5
    6. Glüer CC, Cummings SR, Pressman A, et al. Prediction of hip fractures from pelvic radiographs: the study of osteoporotic fractures. J Bone Mineral Res. 1994; 9(5):671-7. doi: 10.1002/jbmr.5650090512
    7. Yeo AK, Ahrberg AB, Theopold JD, et al. Are radiographic indices reliable indicators for quantitative bone mineral density and vitamin D status after femoral neck fractures? A retrospective study in 112 elderly patients. Patient Safety Surg. 2015; 9(1):1-7. doi: 10.1186/s13037-015-0085-2
    8. James D, Williams S. Determining prevalence of osteoporosis in health-seeking population of rural central India using singh's index: A resource optimization model to fight a silent epidemic. CHRISMED J Health Res. 2018; 5(3):173. doi: 10.4103/cjhr.cjhr_35_18
    9. Gupta G, Rani S, Umar S, Singh S, Haider S, Kumar M. Correlate of radiological indexes for osteoporosis with histological status of osteoid of bone. JDMS. 2016; 15(04):20-8.
    10. Lems WF. Fracture risk estimation may facilitate the treatment gap in osteoporosis.

    Ann Rheum Dis. 2015; 74(11):1943-5. doi: 10.1136/annrheumdis-2015-208245

    1. Epanov VV, Palshin GA, Epanova AA, et al. X-ray densitometry and frax model in predicting the risk of osteoporosis and low-energy fractures in postmenopausal women. Wiad Lek. 2015; 68(4):526-8.
    2. Natu N, Yadav S, Kosta S, Dave A, Kumar R. Detection of osteoporosis in postmenopausal women by singh's index. J South Asian Feder Menopause Soc. 2016; 4(1):8-10. doi: 10.18314/jbo.v1i1.29
    3. Singh M, Nagrath AR, Maini P. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. JBJS. 1970; 52(3):457-67.
The Archives of Bone and Joint Surgery
Volume 12, Issue 1
January 2024
Pages 1-11

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History

  • Receive Date: 03 April 2023
  • Revise Date: 02 December 2023
  • Accept Date: 29 October 2023

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