Abstract
at 100 HU was 68% for osteoporosis and 95% for combined osteoporosis/osteopenia; NPV for osteoporosis at L1 using a cut-off of 200 HU was 99%. Relative to the highest L1 attenuation quintile (O191 HU), the odds ratio for osteoporosis for the lowest L1 attenuation quintile (!112 HU) was 90.6 (95% CI: 41.83-196.40). Comparable performance was seen at all other vertebral levels. Among all patients with compression fractures seen at CT, 62/118 (52.5%) had T-scores 5 -2.5 (DXA false-negatives) while 95.1% had an L1 attenuation !150 HU. Among all patients with an L1 attenuation !150 HU, 96/1007 (9.5%) harbored a vertebral compression fracture. Presence or absence of IV contrast did not meaningfully impact results. Conclusions: Simple lumbar attenuation measurement at CT (e.g., at L1 level) can effectively distinguish osteoporosis from normal, regardless of original study indication or technique. Moderate-to-severe compression fractures identified at CT are frequently associated with non-osteoporotic T-scores by DXA but have abnormally low vertebral attenuation values in the majority of cases. Osteoporosis screening can be performed concomitantly with abdominal CT. This opportunistic approach allows bone mass screening with no additional radiation exposure or cost.
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