Top

Published in:

Open Access 01-12-2017 | Research

Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)

Authors: N. Stewart Pritchard, James M. Smoliga, Anh-Dung Nguyen, Micah C. Branscomb, David R. Sinacore, Jeffrey B. Taylor, Kevin R. Ford

Published in: Journal of Foot and Ankle Research | Issue 1/2017

Abstract

Background

Metatarsal fractures, especially of the fifth metatarsal, are common injuries of the foot in a young athletic population, but the risk factors for this injury are not well understood. Dual-energy x-ray absorptiometry (DXA) provides reliable measures of regional bone mineral density to predict fracture risk in the hip and lumbar spine. Recently, sub-regional metatarsal reliability was established in fresh cadaveric specimens and associated with ultimate fracture force. The purpose of this study was to assess the reliability of DXA bone mineral density measurements of sub-regions of the second and fifth metatarsals in a young, active population.

Methods

Thirty two recreationally active individuals participated in the study, and the bone density of the second (2MT) and fifth (5MT) metatarsals of each subject was measured using a Hologic QDR x-ray bone densitometer. Scans were analyzed separately by two raters, and regional bone mineral density, bone mineral content, and area measurements were calculated for the proximal, shaft, and distal regions of the bone. Intra-rater, inter-rater, and scan-rescan reliability were then determined for each region.

Results

Proximal and shaft bone mineral density measurements of the second and fifth metatarsal were reliable. ICC’s were variable across regions and metatarsals, with the distal region being the poorest.

Conclusions

Bone mineral density measurements of the metatarsals may be a better indicator of fracture risk of the metatarsals than whole body measurements. A reliable method for measuring the regional bone mineral densities of the metatarsals was found. However, inter-rater reliability and scan-rescan reliability for the distal regions were poor. Future research should examine the relationship between DXA bone mineral density measurements and fracture risk at the metatarsals.

Iwamoto J, Sato Y, Takeda T, Matsumoto H. Analysis of stress fractures in athletes based on our clinical experience. World J Orthop. 2011;2:7–12.CrossRefPubMedPubMedCentral

Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury. 2010;41:555–62.CrossRefPubMed

Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66:209–14.CrossRefPubMed

Bowes J, Buckley R. Fifth metatarsal fractures and current treatment. World J Orthop. 2016;7:793–800.CrossRefPubMedPubMedCentral

Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA. Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med. 2007;41:510–4.CrossRefPubMedPubMedCentral

Jain N, Murray D, Kemp S, Calder J. Frequency and trends in foot and ankle injuries within an English premier league football Club using a new impact factor of injury to identify a focus for injury prevention. Foot Ankle Surg. 2014;20:237–40.CrossRefPubMed

Cakir H, Van Vliet-Koppert ST, Van Lieshout EM, De Vries MR, Van Der Elst M, Schepers T. Demographics and outcome of metatarsal fractures. Arch Orthop Trauma Surg. 2011;131:241–5.CrossRefPubMed

Dameron TB Jr. Fractures of the proximal fifth metatarsal: selecting the best treatment option. J Am Acad Orthop Surg. 1995;3:110–4.CrossRefPubMed

Bakkum AJ, Janssen TW, Rolf MP, Roos JC, Burcksen J, Knol DL, de Groot S. A reliable method for measuring proximal tibia and distal femur bone mineral density using dual-energy X-ray absorptiometry. Med Eng Phys. 2014;36:387–90.CrossRefPubMed

10.

Geusens P, De Winter L, Quaden D, Vanhoof J, Vosse D, van den Bergh J, Somers V. The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma. Arthritis Res Ther. 2015;17:294.CrossRefPubMedPubMedCentral

11.

Tenforde AS, Carlson JL, Chang A, Sainani KL, Shultz R, Kim JH, Cutti P, Golden NH, Fredericson M. Association of the Female Athlete Triad Risk Assessment Stratification to the development of bone stress injuries in collegiate athletes. Am J Sports Med. 2017;45:302–10.CrossRefPubMed

12.

Fuller JT, Archer J, Buckley JD, Tsiros MD, Thewlis D. The reliability of dual-energy X-ray absorptiometry measurements of bone mineral density in the metatarsals. Skelet Radiol. 2016;45:135–40.CrossRef

13.

Baim S, Wilson CR, Lewiecki EM, Luckey MM, Downs RW Jr., Lentle BC. Precision assessment and radiation safety for dual-energy X-ray absorptiometry: position paper of the International Society for Clinical Densitometry. J Clin Densitom. 2005;8:371–8.CrossRefPubMed

14.

Bohnert KL, Gutekunst DJ, Hildebolt CF, Sinacore DR. Dual-energy X-ray absorptiometry of human metatarsals: precision, least significant change and association to ex vivo fracture force. Foot (Edinb). 2013;23:63–9.CrossRef

15.

Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19:231–40.PubMed

16.

Commean PK, Ju T, Liu L, Sinacore DR, Hastings MK, Mueller MJ. Tarsal and metatarsal bone mineral density measurement using volumetric quantitative computed tomography. J Digit Imaging. 2009;22:492–502.CrossRefPubMed

17.

Courtney AC, Davis BL, Manning T, Kambic HE. Effects of age, density, and geometry on the bending strength of human metatarsals. Foot Ankle Int. 1997;18:216–21.CrossRefPubMed

18.

Wang J, Tan S, Cao L. Site-specific relationship between bone mineral density and muscle strength or endurance in elderly men. Asian J Exerc Sport Sci. 2014;11:36–45.

19.

Deriaz O, Najafi B, Ballabeni P, Crettenand A, Gobelet C, Aminian K, Rizzoli R, Gremion G. Proximal tibia volumetric bone mineral density is correlated to the magnitude of local acceleration in male long-distance runners. J Appl Physiol (1985). 2010;108:852–7.CrossRef

Title: Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)
Authors: N. Stewart Pritchard
James M. Smoliga
Anh-Dung Nguyen
Micah C. Branscomb
David R. Sinacore
Jeffrey B. Taylor
Kevin R. Ford
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Foot and Ankle Research / Issue 1/2017
Electronic ISSN: 1757-1146
DOI: https://doi.org/10.1186/s13047-017-0234-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

The experience of foot problems and decisions to access foot care in patients with rheumatoid arthritis: a qualitative study

Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

Categorisation of foot complaints in systemic lupus erythematosus (SLE) from a New Zealand cohort

The comparative efficacy of angiosome-directed and indirect revascularisation strategies to aid healing of chronic foot wounds in patients with co-morbid diabetes mellitus and critical limb ischaemia: a literature review

Medical-grade footwear: the impact of fit and comfort

The effect of a running task on muscle shear elastic modulus of posterior lower leg