Utility of clavicle cortex index as a screening tool for low bone mineral density

This retrospective study examined the relationship between the clavicle cortical index (CCI) and dual-energy X-ray absorptiometry (DEXA) bone mineral density (BMD). Data from patients undergoing elective spine and hip surgeries were reviewed, focusing on the bilateral clavicles on chest radiographs. Clavicles were divided into distal, middle-distal, middle-proximal, and proximal. Cortical and trabecular thicknesses were measured in these sections, and the CCI was calculated as (cortical + trabecular)/trabecular bone. The Pearson correlation coefficients were used to assess the CCI and BMDs in the proximal femur, lumbar spine, and distal radius. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of the CCI for osteoporosis (BMD < 70%) and Hounsfield units. The study included 219 patients (mean age, 68.03 years). Mild but significant correlations were found between the bilateral middle-distal CCI and BMD in the radius (r = 0.409), with weaker correlations in the femur (r = 0.313) and spine (r = 0.209). ROC analyses for osteoporosis diagnosis were moderately accurate: 0.69 (0.55-0.83, femur), 0.716 (0.57-0.861, spine), and 0.834 (0.737-0.931, radius). The area under the curve for the Hounsfield units was 0.74 (0.55-0.89). The middle-distal CCI showed a correlation with BMDs, especially in the radius. The easy calculation of CCI using routine chest radiographs makes it a valuable osteoporosis screening tool.