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Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies

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Abstract

Objective

This study observed the distribution of CT attenuation values for T10-L3 vertebral bodies and derived the Hounsfield unit (HU) thresholds using the quantitative computed tomography (QCT) as a reference to predict osteoporosis and normal bone density.

Methods

We included 482 subjects who were scheduled to undergo CT lung cancer screening and pulmonary nodule follow-up from May 2015 to February 2019. The subjects were scanned with the calibration phantom beneath the back while performing a chest CT scan. The volumetric bone mineral density (vBMD) and CT attenuation values of T10-L3 vertebral bodies were measured, and the correlation between the two measurements was analyzed. Receiver operator characteristic (ROC) curves were generated to determine diagnostic optimal thresholds.

Results

A total of 2716 vertebral bodies of 457 participants were measured after exclusion screening. CT attenuation value of each plane’s vertebral body showed a strong correlation with vBMD. The optimal threshold of > 141 HU was 93.5% sensitive and 86.1% specific for the recognition of normal BMD. The optimal threshold of < 102.4 HU was 96.9% specific and 82.1% sensitive for distinguishing osteoporosis from osteopenia and normal BMD. The average CT attenuation values of vertebral bodies with compressed and normal morphology were 108.9 ± 20.6 and 136.8 ± 32.2 HU, respectively.

Conclusion

Sagittal reconstruction of the thoracic vertebrae using routine thoracic CT image combined with CT attenuation value measurements of the spine is valuable for predicting bone mineral density in high-risk populations. The mean CT attenuation values of the vertebral bodies with vertebral compression appearance were lower than that of normal vertebral shape.

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References

  1. Consensus development conference: prophylaxis and treatment of osteoporosis. Conference report. Am J Med. 1991;90(1):107–10. https://doi.org/10.1016/0002-9343(91)90512-v.

  2. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Conference report. Am J Med. 1993;94(6):646–50. https://doi.org/10.1016/0002-9343(93)90218-e.

  3. Kern LM, Powe NR, Levine MA, et al. Association between screening for osteoporosis and the incidence of hip fracture. Ann Intern Med. 2005;142(3):173–81.

    Article  Google Scholar 

  4. Barr RJ, Stewart A, Torgerson DJ, et al. Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk. Osteoporos Int. 2010;21(4):561–8.

    Article  CAS  Google Scholar 

  5. Li N, Li XM, Xu L, et al. Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women. Int J Endocrinol. 2013;2013:895474.

    PubMed  PubMed Central  Google Scholar 

  6. Bolotin HH. DXA in vivo BMD methodology: an erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling. Bone. 2007;41(1):138–54.

    Article  CAS  Google Scholar 

  7. Ma XH, Zhang W, Wang Y, et al. Comparison of the spine and hip BMD assessments derived from quantitative computed tomography. Int J Endocrinol. 2015;2015:675340.

    Article  Google Scholar 

  8. Fountoulis G, Kerenidi T, Kokkinis C, et al. Assessment of bone mineral density in male patients with chronic obstructive pulmonary disease by DXA and quantitative computed tomography. Int J Endocrinol. 2016;2016:6169721.

    Article  Google Scholar 

  9. Silva IM, Freitas DQ, Ambrosano GM, et al. Bone density: comparative evaluation of Hounsfield units in multislice and cone-beam computed tomography. Braz Oral Res. 2012;26(6):550–6.

    Article  Google Scholar 

  10. Turkyilmaz I, Tumer C, Ozbek EN, et al. Relations between the bone density values from computerized tomography, and implant stability parameters: a clinical study of 230 regular platform implants. J Clin Periodontol. 2007;34(8):716–22.

    Article  Google Scholar 

  11. Schwaiger BJ, Kopperdahl DL, Nardo L, et al. Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. Bone. 2017;101:62–9.

    Article  Google Scholar 

  12. Pickhardt PJ, Pooler BD, Lauder T, et al. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588–95.

    Article  Google Scholar 

  13. Buckens CF, Dijkhuis G, de Keizer B, et al. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol. 2015;25(7):2074–9.

    Article  Google Scholar 

  14. Lee SJ, Binkley N, Lubner MG, et al. Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 2016;27(3):1131–6.

    Article  CAS  Google Scholar 

  15. Marinova M, Edon B, Wolter K, et al. Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis. Curr Med Res Opin. 2015;31(10):1871–81.

    Article  Google Scholar 

  16. Jain RK, Lee E, Mathai C, et al. Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes. Osteoporos Int. 2020. https://doi.org/10.1007/s00198-020-05521-x.

  17. American College of Radiology. ACR-SPR-SSR Practice Parameter for the Performance of Quantitative Computed Tomography (QCT) Bone Densitometry (Amended 2014 Resolution 39). Reston: American College of Radiology. 2008. http://www.acr.org/~/media/ACR/PGTS/PGTS/guidelines/QCT.pdf. Accessed 15 Dec 2015.

  18. Pickhardt PJ, Lee LJ, del Rio AM, et al. Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J Bone Miner Res. 2011;26(9):2194–203.

    Article  Google Scholar 

  19. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137–48.

    Article  CAS  Google Scholar 

  20. Oudkerk M, Devaraj A, Vliegenthart R, et al. European position statement on lung cancer screening. Lancet Oncol. 2017;18(12):e754–66.

    Article  Google Scholar 

  21. Nawa T, Fukui K, Nakayama T, et al. A population-based cohort study to evaluate the effectiveness of lung cancer screening using low-dose CT in Hitachi city, Japan. Jpn J Clin Oncol. 2019;49(2):130–6.

    Article  Google Scholar 

  22. Iwamoto J, Takeda T, Ichimura S, et al. Age-related changes in cortical bone in men: metacarpal bone mass measurement study. J Orthop Sci. 2000;5(1):4–9.

    Article  CAS  Google Scholar 

  23. Li H, Wallin M, Barregard L, et al. Smoking-induced risk of osteoporosis is partly mediated by cadmium from tobacco smoke: the MrOS Sweden study. J Bone Miner Res. 2020. https://doi.org/10.1002/jbmr.4014.

  24. Ho-Pham LT, Tran B, Do AT, et al. Association between pre-diabetes, type 2 diabetes and trabecular bone score: the Vietnam osteoporosis study. Diabetes Res Clin Pract. 2019;155:107790.

    Article  Google Scholar 

  25. Marshall K, Teo L, Shanahan C, et al. Inadequate calcium and vitamin D intake and osteoporosis risk in older Americans living in poverty with food insecurities. PLoS One. 2020;15(7):e0235042.

    Article  CAS  Google Scholar 

  26. Gausden EB, Nwachukwu BU, Schreiber JJ, et al. Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am. 2017;99(18):1580–90.

    Article  Google Scholar 

  27. Zaidi Q, Danisa OA, Cheng W. Measurement techniques and utility of Hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine (Phila Pa 1976). 2019;44(4):E239–44.

    Article  Google Scholar 

  28. Mao YF, Zhang Y, Li K, et al. Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat. 2019;16:33–9.

    Article  Google Scholar 

  29. Unnanuntana A, Gladnick BP, Donnelly E, et al. The assessment of fracture risk. J Bone Joint Surg Am. 2010;92(3):743–53.

    Article  Google Scholar 

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Acknowledgements

We would like to express our sincere thanks to Dr. Zhao Lianping for her constructive suggestions and help under the revision process. This study was partially supported by the fund “Lanzhou Guiding Science Foundation project: 2019-ZD-108”. It was also funded by the “Gansu provincial hospital foundation (code: 16GSSY7-7)”.

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Author notes

  1. P.W. and W.S. contributed equally to this study and share first authorship.

Authors and Affiliations

  1. Department of Radiology, Gansu Provincial Hospital, No.204, Donggang West Street, Chengguan District, Lanzhou, 730000, Gansu, China

    Ping Wang, Zeqing Mao, Xing Zhou, Yu Li, Jinjin Niu, Min Jiang & Gang Huang

  2. Department of orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, China

    Wei She

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  1. Ping Wang
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  2. Wei She
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  5. Yu Li
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Correspondence to Gang Huang.

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Wang, P., She, W., Mao, Z. et al. Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies. Skeletal Radiol 50, 371–379 (2021). https://doi.org/10.1007/s00256-020-03573-y

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  • DOI: https://doi.org/10.1007/s00256-020-03573-y

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