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In the paper by Drs Williams and Daymond they state that heel densitometry could not be used for diagnosis of osteoporosis [1]. This is based on their findings of many false negatives when comparing with axial densitometry. However, the conclusions are based on just one device and should not be generalized to all devices that measure bone density in the heel bone. In the much larger study on different peripheral devices conducted by Dr Siris et al [2], 200 000 post-menopausal women were measured and diagnosed by different peripheral devices. The results show that the prediction of hip fracture from heel densitometry is as good as measurements of the hip itself. No single measurement (peripheral or axial) identifies all patients with low bone density, the study shows however the practical clinical value of information derived from single-site peripheral measurements in post-menopausal women. The heel bone as a measurement site has been validated by numerous others and shown to be highly predictive of fracture risk and useful as an aid to make therapeutic decisions [3–5]. The T-scores for peripheral devices may sometimes not be in concordance with T-scores derived from axial measurements, however similar discrepancies exist for T-scores between hip and spine [6, 7]. The evaluation of one device does not necessarily imply that all devices that measure the same site are performing equally.
Yours etc.,
Department of Radiology, County Hospital, SE-301 85 Halmstad, Sweden
Received for publication May 17, 2003. Accepted for publication July 17, 2003.
References
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