nach oben

Erschienen in:

03.08.2020 | Original Article

Bone density and strength from thoracic and lumbar CT scans both predict incident vertebral fractures independently of fracture location

verfasst von: F. Johannesdottir, B. Allaire, D.L. Kopperdahl, T.M. Keaveny, S. Sigurdsson, M.A. Bredella, D.E. Anderson, E.J. Samelson, D.P. Kiel, V.G. Gudnason, M.L. Bouxsein

Erschienen in: Osteoporosis International | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Summary

In a population-based study, we found that computed tomography (CT)-based bone density and strength measures from the thoracic spine predicted new vertebral fracture as well as measures from the lumbar spine, suggesting that CT scans at either the thorax or abdominal regions are useful to assess vertebral fracture risk.

Introduction

Prior studies have shown that computed tomography (CT)-based lumbar bone density and strength measurements predict incident vertebral fracture. This study investigated whether CT-based bone density and strength measurements from the thoracic spine predict incident vertebral fracture and compared the performance of thoracic and lumbar bone measurements to predict incident vertebral fracture.

Methods

This case-control study of community-based men and women (age 74.6 ± 6.6) included 135 cases with incident vertebral fracture at any level and 266 age- and sex-matched controls. We used baseline CT scans to measure integral and trabecular volumetric bone mineral density (vBMD) and vertebral strength (via finite element analysis, FEA) at the T8 and L2 levels. Association between these measurements and vertebral fracture was determined by using conditional logistic regression. Sensitivity and specificity for predicting incident vertebral fracture were determined for lumbar spine and thoracic bone measurements.

Results

Bone measurements from T8 and L2 predicted incident vertebral fracture equally well, regardless of fracture location. Specifically, for predicting vertebral fracture at any level, the odds ratio (per 1-SD decrease) for the vBMD and strength measurements at L2 and T8 ranged from 2.0 to 2.7 (p < 0.0001) and 1.8 to 2.8 (p < 0.0001), respectively. Results were similar when predicting fracture only in the thoracic versus the thoracolumbar spine. Lumbar and thoracic spine bone measurements had similar sensitivity and specificity for predicting incident vertebral fracture.

Conclusion

These findings indicated that like those from the lumbar spine, CT-based bone density and strength measurements from the thoracic spine may be useful for identifying individuals at high risk for vertebral fracture.

Nur mit Berechtigung zugänglich

Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22(3):465–475. https://doi.org/10.1359/jbmr.061113CrossRefPubMed

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of osteoporotic fractures research group. J Bone Miner Res 14(5):821–828. https://doi.org/10.1359/jbmr.1999.14.5.821CrossRefPubMed

Agten CA, Ramme AJ, Kang S, Honig S, Chang G (2017) Cost-effectiveness of virtual bone strength testing in osteoporosis screening programs for postmenopausal women in the United States. Radiology 285(2):506–517. https://doi.org/10.1148/radiol.2017161259CrossRefPubMedPubMedCentral

Khosla S, Shane E (2016) A crisis in the treatment of osteoporosis. J Bone Miner Res 31(8):1485–1487. https://doi.org/10.1002/jbmr.2888CrossRefPubMed

Miller PD (2016) Underdiagnosis and undertreatment of osteoporosis: the battle to be won. J Clin Endocrinol Metab 101(3):852–859. https://doi.org/10.1210/jc.2015-3156CrossRefPubMed

Cosman F, Krege JH, Looker AC, Schousboe JT, Fan B, Sarafrazi Isfahani N, Shepherd JA, Krohn KD, Steiger P, Wilson KE, Genant HK (2017) Spine fracture prevalence in a nationally representative sample of US women and men aged >/=40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 28(6):1857–1866. https://doi.org/10.1007/s00198-017-3948-9CrossRefPubMedPubMedCentral

Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone 34(1):195–202. https://doi.org/10.1016/j.bone.2003.10.001CrossRefPubMed

Zhang J, Delzell E, Zhao H, Laster AJ, Saag KG, Kilgore ML, Morrisey MA, Wright NC, Yun H, Curtis JR (2012) Central DXA utilization shifts from office-based to hospital-based settings among Medicare beneficiaries in the wake of reimbursement changes. J Bone Miner Res 27(4):858–864. https://doi.org/10.1002/jbmr.1534CrossRefPubMed

Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM (2017) Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 99(18):1580–1590. https://doi.org/10.2106/jbjs.16.00749CrossRefPubMed

10.

Chalhoub D, Orwoll ES, Cawthon PM, Ensrud KE, Boudreau R, Greenspan S, Newman AB, Zmuda J, Bauer D, Cummings S, Cauley JA (2016) Areal and volumetric bone mineral density and risk of multiple types of fracture in older men. Bone 92:100–106. https://doi.org/10.1016/j.bone.2016.08.014CrossRefPubMedPubMedCentral

11.

Kopperdahl DL, Aspelund T, Hoffmann PF, Sigurdsson S, Siggeirsdottir K, Harris TB, Gudnason V, Keaveny TM (2014) Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans. J Bone Miner Res 29(3):570–580. https://doi.org/10.1002/jbmr.2069CrossRefPubMedPubMedCentral

12.

Wang X, Sanyal A, Cawthon PM, Palermo L, Jekir M, Christensen J, Ensrud KE, Cummings SR, Orwoll E, Black DM, Keaveny TM (2012) Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res 27(4):808–816. https://doi.org/10.1002/jbmr.1539CrossRefPubMedPubMedCentral

13.

Allaire BT, Lu D, Johannesdottir F, Kopperdahl D, Keaveny TM, Jarraya M, Guermazi A, Bredella MA, Samelson EJ, Kiel DP, Anderson DE, Demissie S, Bouxsein ML (2018) Prediction of incident vertebral fracture using CT-based finite element analysis. Osteoporos Int 30:323–331. https://doi.org/10.1007/s00198-018-4716-1CrossRefPubMedPubMedCentral

14.

Löffler MT, Jacob A, Valentinitsch A, Rienmüller A, Zimmer C, Ryang Y-M, Baum T, Kirschke JS (2019) Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. Eur Radiol 29(9):4980–4989. https://doi.org/10.1007/s00330-019-06018-wCrossRefPubMedPubMedCentral

15.

ACR-SPR-SSR (2018) Practice parameters for the performance of musculoskeletal quantitative computed tomography (QCT). American College of Radiology. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/QCT.pdf. Accessed 1 Sept 2019.

16.

Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42(3):467–475. https://doi.org/10.1016/j.bone.2007.11.001CrossRefPubMed

17.

Harris TB, Launer LJ, Eiriksdottir G, Kjartansson O, Jonsson PV, Sigurdsson G, Thorgeirsson G, Aspelund T, Garcia ME, Cotch MF, Hoffman HJ, Gudnason V (2007) Age, gene/environment susceptibility-Reykjavik study: multidisciplinary applied phenomics. Am J Epidemiol 165(9):1076–1087. https://doi.org/10.1093/aje/kwk115CrossRefPubMedPubMedCentral

18.

Sigurdsson G, Aspelund T, Chang M, Jonsdottir B, Sigurdsson S, Eiriksdottir G, Gudmundsson A, Harris TB, Gudnason V, Lang TF (2006) Increasing sex difference in bone strength in old age: the age, gene/environment susceptibility-Reykjavik study (AGES-REYKJAVIK). Bone 39(3):644–651. https://doi.org/10.1016/j.bone.2006.03.020CrossRefPubMed

19.

Gudmundsson EF, Gudnason V, Sigurdsson S, Launer LJ, Harris TB, Aspelund T (2012) Coronary artery calcium distributions in older persons in the AGES-Reykjavik study. Eur J Epidemiol 27(9):673–687. https://doi.org/10.1007/s10654-012-9730-6CrossRefPubMedPubMedCentral

20.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148. https://doi.org/10.1002/jbmr.5650080915CrossRefPubMed

21.

Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The fracture intervention trial research group. Bone 25(5):613–619CrossRef

22.

Anderson DE, Demissie S, Allaire BT, Bruno AG, Kopperdahl DL, Keaveny TM, Kiel DP, Bouxsein ML (2014) The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture. Osteoporos Int 25(2):559–566. https://doi.org/10.1007/s00198-013-2452-0CrossRefPubMed

23.

Schousboe JT (2016) Epidemiology of vertebral fractures. J Clin Densitom 19(1):8–22. https://doi.org/10.1016/j.jocd.2015.08.004CrossRefPubMed

24.

Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA (2002) The incidence of vertebral fractures in men and women: the Rotterdam study. J Bone Miner Res 17(6):1051–1056. https://doi.org/10.1359/jbmr.2002.17.6.1051CrossRefPubMed

25.

Lee DC, Hoffmann PF, Kopperdahl DL, Keaveny TM (2017) Phantomless calibration of CT scans for measurement of BMD and bone strength-inter-operator reanalysis precision. Bone 103:325–333. https://doi.org/10.1016/j.bone.2017.07.029CrossRefPubMedPubMedCentral

26.

Budoff MJ, Hamirani YS, Gao YL, Ismaeel H, Flores FR, Child J, Carson S, Nee JN, Mao S (2010) Measurement of thoracic bone mineral density with quantitative CT. Radiology 257(2):434–440. https://doi.org/10.1148/radiol.10100132CrossRefPubMed

27.

Weishaupt D, Schweitzer ME, DiCuccio MN, Whitley PE (2001) Relationships of cervical, thoracic, and lumbar bone mineral density by quantitative CT. J Comput Assist Tomogr 25(1):146–150. https://doi.org/10.1097/00004728-200101000-00027CrossRefPubMed

28.

Mao SS, Li D, Syed YS, Gao Y, Luo Y, Flores F, Child J, Cervantes M, Kalantar-Zadeh K, Budoff MJ (2017) Thoracic quantitative computed tomography (QCT) can sensitively monitor bone mineral metabolism: comparison of thoracic QCT vs lumbar QCT and dual-energy X-ray absorptiometry in detection of age-relative change in bone mineral density. Acad Radiol 24(12):1582–1587. https://doi.org/10.1016/j.acra.2017.06.013CrossRefPubMed

29.

Fang J, Franconeri A, Boos J, Nimhuircheartaigh J, Zhang Z, Brook A, Brook OR (2018) Opportunistic bone density measurement on abdomen and pelvis computed tomography to predict fracture risk in women aged 50 to 64 years without osteoporosis risk factors. J Comput Assist Tomogr 42(5):798–806. https://doi.org/10.1097/RCT.0000000000000744CrossRefPubMed

30.

Lassemillante A-CM, Doi SAR, Hooper JD, Prins JB, Wright ORL (2014) Prevalence of osteoporosis in prostate cancer survivors: a meta-analysis. Endocrine 45(3):370–381. https://doi.org/10.1007/s12020-013-0083-zCrossRefPubMed

31.

Targownik LE, Bernstein CN, Leslie WD (2014) Risk factors and management of osteoporosis in inflammatory bowel disease. Curr Opin Gastroenterol 30(2):168–174. https://doi.org/10.1097/mog.0000000000000037CrossRefPubMed

32.

Engelke K (2017) Quantitative computed tomography-current status and new developments. J Clin Densitom 20(3):309–321. https://doi.org/10.1016/j.jocd.2017.06.017CrossRefPubMed

33.

Pickhardt PJ, Bodeen G, Brett A, Brown JK, Binkley N (2015) Comparison of femoral neck BMD evaluation obtained using lunar DXA and QCT with asynchronous calibration from CT colonography. J Clin Densitom 18(1):5–12. https://doi.org/10.1016/j.jocd.2014.03.002CrossRefPubMed

34.

Bodeen G, Brown J, Brett A (2014) Prospective comparison of QCT BMD measurement using either asynchronous or simultaneous calibration at the femoral neck and lumbar spine. Osteoporos Int 25:S294–S294

35.

Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD (2007) Low bone mineral density and fracture burden in postmenopausal women. Can Med Assoc J 177(6):575–580. https://doi.org/10.1503/cmaj.070234CrossRef

36.

Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18(11):1947–1954. https://doi.org/10.1359/jbmr.2003.18.11.1947CrossRefPubMed

37.

Bauer JS, Henning TD, Müeller D, Lu Y, Majumdar S, Link TM (2007) Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors. AJR Am J Roentgenol 188(5):1294–1301. https://doi.org/10.2214/AJR.06.1006CrossRefPubMed

38.

Kaesmacher J, Liebl H, Baum T, Kirschke JS (2017) Bone mineral density estimations from routine multidetector computed tomography: a comparative study of contrast and calibration effects. J Comput Assist Tomogr 41(2):217–223. https://doi.org/10.1097/rct.0000000000000518CrossRefPubMedPubMedCentral

39.

Acu K, Scheel M, Issever AS (2014) Time dependency of bone density estimation from computed tomography with intravenous contrast agent administration. Osteoporos Int 25(2):535–542. https://doi.org/10.1007/s00198-013-2440-4CrossRefPubMed

Titel: Bone density and strength from thoracic and lumbar CT scans both predict incident vertebral fractures independently of fracture location
verfasst von: F. Johannesdottir
B. Allaire
D.L. Kopperdahl
T.M. Keaveny
S. Sigurdsson
M.A. Bredella
D.E. Anderson
E.J. Samelson
D.P. Kiel
V.G. Gudnason
M.L. Bouxsein
Publikationsdatum: 03.08.2020
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 2/2021
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05528-4

Identification of non-Hodgkin lymphoma patients at risk for treatment-related vertebral density loss and fractures

Open Access
Original Article

Longitudinal change in bone mineral density among Chinese individuals with HIV after initiation of antiretroviral therapy

Original Article

Incidence of subsequent osteoporotic fractures after distal radius fractures and mortality of the subsequent distal radius fractures: a retrospective analysis of claims data of the Korea National Health Insurance Service

Original Article

Characteristics of incidence hip fracture cases in older adults participating in the longitudinal AGES-Reykjavik study

Original Article

A unique case of light chain (AL) amyloidosis masquerading as hypophosphatemic osteomalacia

Case Report

Bone mineral density and fracture risk in adult patients with hypophosphatasia

Open Access
Original Article

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Was sich Menschen mit Frozen Shoulder wünschen

10.01.2025
Schultersteife
Nachrichten

Die Capsulitis adhaesiva des Glenohumeralgelenks, auch als Frozen Shoulder bezeichnet, belastet die Betroffenen weit über die körperlichen Beschwerden hinaus, wie eine italienische Studie ergeben hat.

Restriktive Sauerstoffgabe ohne Vorteil bei schwerem Trauma

09.01.2025
Traumatologische Notfallmedizin
Nachrichten

Ob schwer verletzte Personen besser restriktiv oder liberal mit Sauerstoff versorgt werden sollten, hat die Arbeitsgruppe der TRAUMOX2-Studie untersucht – mit klarem Ergebnis.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Bone density and strength from thoracic and lumbar CT scans both predict incident vertebral fractures independently of fracture location