Introduction: Computed tomography (CT) measurements of bone mineral attenuation may be a useful means to identify older women who should be prioritized for bone mineral density screening. Methods: We compared bone mineral attenuation as measured in the L1 vertebra of CT studies to the results of dual-energy x-ray absorptiometry (DEXA) studies to determine what CT attenuation thresholds might yield a reasonable combination of sensitivity and specificity for the detection of osteoporosis. The study was limited to women between the ages of 65 and 75 years who had a DEXA study and a CT that included the L1 or adjacent vertebra performed within 3 years of the DEXA study. Results: There were 1226 women in this study, of whom 452 (38%) had osteoporosis based on a T-score ≤ ？2.5 by DEXA. There were 830 CT studies performed with contrast and 396 studies which were performed without contrast. There was a statistically significant difference in the mean HU of those studies performed without contrast compared to those with contrast (unenhanced mean 103 HU versus 125 HU, p < 0.001). Different CT attenuation thresholds provided the most appropriate combination of sensitivity and specificity for the detection of osteoporosis when comparing CT studies performed without or with IV contrast and when all the CT data were used in aggregate. Conclusion: Different thresholds appear necessary when using the mean CT vertebral attenuation to identify older women for preferential referral for DEXA studies.
References
[1]
Hansen, D., Pelizzari, P. and Pyenson, B. (2021) The Clinical and Cost Burden of Fractures Associated with Osteoporosis. Milliman Research Report.
[2]
Cosman, F., de Beur, S.J., LeBoff, M.S., et al. (2014) Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporosis International, 25, 2359-2381. https://doi.org/10.1007/s00198-014-2794-2
[3]
Bone Health & Osteoporosis Foundation. New Report on Burden of Osteoporosis Highlights Huge and Growing Economic and Human Toll of the Disease. https://www.bonehealthandosteoporosis.org/news/new-report-on-burden-of-osteoporosis-highlights-huge-and-growing-economic-and-human-toll-of-the-disease/
[4]
Singer, A., Exuzides, A., Spangler, L., et al. (2015) Burden of Illness for Osteoporotic Fractures Compared with Other Serious Diseases among Postmenopausal Women in the United States. Mayo Clinic Proceedings, 90, 53-62. https://doi.org/10.1016/j.mayocp.2014.09.011
[5]
Merlijn, T., Swart, K.M.A., van der Horst, H.E., Netelenbos, J.C. and Elders, P.J.M. (2020) Fracture Prevention by Screening for High Fracture Risk: A Systematic Review and Meta-Analysis. Osteoporosis International, 31, 251-257. https://doi.org/10.1007/s00198-019-05226-w
[6]
Sangondimath, G., Sen, R.K., et al. (2023) DEXA and Imaging in Osteoporosis. Indian Journal of Orthopaedics, 57, 82-93. https://doi.org/10.1007/s43465-023-01059-2
[7]
Martel, D., Monga, A. and Chang, G. (2022) Osteoporosis Imaging. Radiologic Clinics of North America, 60, 537-545. https://doi.org/10.1016/j.rcl.2022.02.003
[8]
Blake, G.M. and Fogelman, I. (2009) The Clinical Role of Dual Energy X-Ray Absorptiometry. European Journal of Radiology, 71, 406-414. https://doi.org/10.1016/j.ejrad.2008.04.062
[9]
US Preventive Services Task Force, Curry, S.J., Krist, A.H., Owens, D.K., Barry, M.J., Caughey, A.B., Davidson, K.W., Doubeni, C.A., Epling, J.W, Kemper, A.R., Kubik, M., Landefeld, C.S., Mangione, C.M., Phipps, M.G., Pignone, M., Silverstein, M., Simon, M.A., Tseng, C.W. and Wong, J.B. (2018) Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA, 319, 2521-2531. https://doi.org/10.1001/jama.2018.7498
[10]
Munce, S.E., Allin, S., Carlin, L., Sale, J., Hawker, G., Kim, S., Butt, D.A., Polidoulis, I., Tu, K. and Jaglal, S.B. (2016) Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study. Journal of Osteoporosis, 2016, Article ID: 2937426. https://doi.org/10.1155/2016/2937426
[11]
Ahern, D.P., McDonnell, J.M., Riffault, M., Evans, S., Wagner, S.C., Vaccaro, A.R., Hoey, D.A. and Butler, J.S. (2021) A Meta-Analysis of the Diagnostic Accuracy of Hounsfield Units on Computed Topography Relative to Dual-Energy X-Ray Absorptiometry for the Diagnosis of Osteoporosis in the Spine Surgery Population. The Spine Journal, 21, 1738-1749. https://doi.org/10.1016/j.spinee.2021.03.008
[12]
Ruiz-Esteves, K.N., Teysir, J., Schatoff, D., Yu, E.W. and Burnett-Bowie, S.M. (2022) Disparities in Osteoporosis Care among Postmenopausal Women in the United States. Maturitas, 156, 25-29. https://doi.org/10.1016/j.maturitas.2021.10.010
[13]
Pickhardt, P.J., Pooler, B.D., Lauder, T., del Rio, A.M., Bruce, R.J. and Binkley, N. (2013) Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Annals of Internal Medicine, 158, 588-595. https://doi.org/10.7326/0003-4819-158-8-201304160-00003
[14]
Buckens, C.F., Dijkhuis, G., de Keizer, B., Verhaar, H.J. and de Jong, P.A. (2015) Opportunistic Screening for Osteoporosis on Routine Computed Tomography? An External Validation Study. European Radiology, 25, 2074-2079. https://doi.org/10.1007/s00330-014-3584-0
[15]
Kim, Y.W., Kim, J.H., Yoon, S.H., Lee, J.H., Lee, C.H., Shin, C.S. and Park, Y.S. (2017) Vertebral Bone Attenuation on Low-Dose Chest CT: Quantitative Volumetric Analysis for Bone Fragility Assessment. Osteoporosis International, 28, 329-338. https://doi.org/10.1007/s00198-016-3724-2
[16]
Zou, D., Li, W., Deng, C., Du, G. and Xu, N. (2019) The Use of CT Hounsfield Unit Values to Identify the Undiagnosed Spinal Osteoporosis in Patients with Lumbar Degenerative Diseases. European Spine Journal, 28, 1758-1766. https://doi.org/10.1007/s00586-018-5776-9
[17]
Kim, K.J., Kim, D.H., Lee, J.I., Choi, B.K., Han, I.H. and Nam, K.H. (2019) Hounsfield Units on Lumbar Computed Tomography for Predicting Regional Bone Mineral Density. Open Medicine (Warsaw, Poland), 14, 545-551. https://doi.org/10.1515/med-2019-0061
[18]
Zou, D., Jiang, S., Zhou, S.Y., Sun, Z.R., Zhong, W.Q., Du, G.H. and Li, W.S. (2020) Prevalence of Osteoporosis in Patients Undergoing Lumbar Fusion for Lumbar Degenerative Diseases: A Combination of DXA and Hounsfield Units. Spine, 45, E406-E410. https://doi.org/10.1097/BRS.0000000000003284
[19]
Cansu, A., Atasoy, D., Eyüboğlu, I. and Karkucak, M. (2020) Diagnostic Efficacy of Routine Contrast-Enhanced Abdominal CT for the Assessment of Osteoporosis in the Turkish Population. Turkish Journal of Medical Sciences, 50, 110-116.
[20]
Berger-Groch, J., Thiesen, D.M., Ntalos, D., Hennes, F. and Hartel, M.J. (2020) Assessment of Bone Quality at the Lumbar and Sacral Spine Using CT Scans: A Retrospective Feasibility Study in 50 Comparing CT and DXA Data. European Spine Journal, 29, 1098-1104. https://doi.org/10.1007/s00586-020-06292-z
[21]
Vadera, S., Osborne, T., Shah, V. and Stephenson, J.A. (2023) Opportunistic Screening for Osteoporosis by Abdominal CT in a British Population. Insights into Imaging, 14, Article No. 57. https://doi.org/10.1186/s13244-023-01400-1
[22]
Gourlay, M.L., Fine, J.P., Preisser, J.S., May, R.C., Li, C., Lui, L.Y., Ransohoff, D.F., Cauley, J.A., Ensrud, K.E. and Study of Osteoporotic Fractures Research Group (2012) Bone-Density Testing Interval and Transition to Osteoporosis in Older Women. The New England Journal of Medicine, 366, 225-233. https://doi.org/10.1056/NEJMoa1107142
[23]
Park, H., Yang, H., Heo, J., Jang, H.W., Chung, J.H., Kim, T.H., Min, Y.K. and Kim, S.W. (2022) Bone Mineral Density Screening Interval and Transition to Osteoporosis in Asian Women. Endocrinology and Metabolism (Seoul), 37, 506-512. https://doi.org/10.3803/EnM.2022.1429
[24]
Händel, M.N., Cardoso, I., von Bülow, C., Rohde, J.F., Ussing, A., Nielsen, S.M., Christensen, R., Body, J.J., Brandi, M.L., Diez-Perez, A., Hadji, P., Javaid, M.K., Lems, W.F., Nogues, X., Roux, C., Minisola, S., Kurth, A., Thomas, T., Prieto-Alhambra, D., Ferrari, S.L., Langdahl, B. and Abrahamsen, B. (2023) Fracture Risk Reduction and Safety by Osteoporosis Treatment Compared with Placebo or Active Comparator in Postmenopausal Women: Systematic Review, Network Meta-Analysis, and Meta-Regression Analysis of Randomised Clinical Trials. BMJ, 381, e068033. https://doi.org/10.1136/bmj-2021-068033
