Characteristics of vertebral CT Hounsfield units in elderly patients with acute vertebral fragility fractures

To explore the characteristics of vertebral CT Hounsfield units (HU) in elderly patients with acute vertebral fragility fractures.

A total of 299 patients aged ≥ 65 years with acute vertebral fragility fractures were retrospectively reviewed, and 77 patients of them were age- and sex-matched with 77 control patients without any fractures. The vertebral HU value of L1(L1-HU) was measured, and T12 and L2 were used as alternatives for L1 in the case of L1 fracture.

There were 460 thoracic and lumbar vertebral fractures in the 299 elderly patients, including 349 acute vertebral fragility fractures and 111 chronic fractures. The average L1-HU value was 66.0 ± 30.6 HU and showed significant difference among patients having different numbers of vertebral fractures (one fracture: 73.3 ± 27.0 HU, two fractures: 58.7 ± 32.5 HU, three or more fractures: 40.7 ± 28.8 HU; P < 0.001). As for the 1:1 age- and sex-matched patients, the L1-HU of the 77 patients with fractures was lower than that of the control patients (70.6 ± 23.4 HU vs. 101.5 ± 36.2 HU, P < 0.001). The area under the receiver operating characteristic curve of using L1-HU to differentiate patients with fractures from controls was 0.77(95% CI 0.70–0.85, P < 0.001). The cutoff value had high specificity of 90% or high sensitivity of 90% to identify patients with fractures of 60 HU and 100 HU, respectively.

The elderly patients with acute vertebral fragility fractures have much lower HU values than those without fractures. Moreover, the lower the vertebral HU value is, the more likely the patients have more than one vertebral fracture.

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