An Easy Way to Save a Life in the Hand Clinic

A quick (but purposeful) look at a hand x-ray is nearly as good as a DEXA scan for identifying patients with osteoporosis.

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Smart Practice: With a free app and a simple plain x-ray sign (second metacarpal cortical percentage), you can identify patients who are very likely to benefit from management of their osteoporosis. Save a life in the hand clinic!

What’s the Claim?

A simple measurement that any of us can make using a free app (BoneGauge; Harborlight Solutions LLC) and a plain radiograph of the hand correlates well with the diagnosis of a life-threatening condition — osteoporosis. The app measures the second metacarpal cortical percentage (2MCP) from a photograph of an x-ray on your smartphone, and when it is <50%, the study found it to be perfectly sensitive and specific in identifying patients with osteoporosis. When the 2MCP is <60%, it was still 94% sensitive and 83% specific.

All this can be done in a minute or so. I tried it, and it works.

The calculation involves measuring the transverse diameter of the second metacarpal at its narrowest part (defined as “A”) and measuring at that same level the intramedullary canal’s width (defined as “B”). The app then calculates the 2MCP score through the formula [(A-B)/A] x 100, generating a cortical percentage score. You can do this yourself if you don’t want to use the app.

How’s It Stack Up?