Dual-Energy Projection Radiography in the Evaluation of Femoral Neck Strength, Density, and Mineralization

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Abstract
Two different dual-energy projection radiography techniques were utilized in an attempt to predict [human] femoral neck strength, bone density and bone mineral content in 19 pairs of cadaver specimens. Positive simple linear correlation was observed between dual-energy scanned projection measurements and dry density, ash fraction, cross-sectional cortical bone area and, to a lesser degree, force required for fracture, but not trabecular bone volume, failure time or Singh trabecular grade. Dual-energy film radiography was found to be a less reliable indicator of femoral neck strength, density and mineral content. Dual-energy scanned projection results related linearly to mineral-equivalent solution (K2HPO4) concentration, and demonstrated long-term reproducibility in repeated specimen studies. Correction factors derived to account for differences in femoral size and rotation were shown to be reliable over a moderate range of neck projections. Although bone mineral measurement at other sites may provide comparable or greater information concerning hip fracture risk, dual-energy scanned projection radiography appears to be a useful technique for assessment of bone density, mineral content and strength in the femoral neck.