Abstract
In this case-control study the value of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) to identify patients with incident osteoporotic vertebral fractures in routine multi-detector computed tomography (MDCT) exams was assessed. Material and methods: Seventeen patients who underwent baseline and follow-up routine contrast-enhanced MDCT and had an incident osteoporotic vertebral fracture at follow-up were included. Seventeen age-, sex- and follow-up duration-matched controls were identified. Trabecular BMD (from Th5 to L5) as well as cross-sectional area of SAT and VAT were extracted. Results: BMD performed best to differentiate patients with an incident fracture from controls at the levels of Th5 (area under the curve [AUC] = 0.781, p = 0.014), Th7 (AUC = 0.877, p = 0.001), and Th9 (AUC = 0.818, p = 0.005). Applying multivariate logistic regression BMD at Th7 level remained the only significant predictor of incident vertebral fractures (Th5-L5) with an odds ratio of 1.07 per BMD SD decrease. VAT and SAT did not show significant differences between the fracture and control group (p > 0.05). Conclusion: The local BMD measurement appears to be more suitable than standard mean BMD from L1–L3 for fracture risk assessment.
Highlights
The goal of this case-control study was to evaluate the performance of bone mineral density (BMD) at different vertebral levels, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) acquired with routine multi-detector computed tomography (MDCT) for future fracture risk assessment in an oncologic cohort
In multivariate logistic regression models, BMD at Th7 level remained the only significant predictor of incident vertebral fractures for all included vertebral levels (Th5-L5), with an odds ratio of 1.07 per BMD standard deviation (SD) decrease (95% confidence interval: 1.01–1.14). In this case-control study, we assessed the ability of local BMD, VAT, and SAT measured in routine MDCT to predict incident vertebral fractures
Allaire et al compared different parameters circumscribing osseous mineral content at the level of L3 using finite element analysis with regard to their potential to predict incident vertebral fractures [30]. They reported an area under the curve (AUC) with higher discriminative power for the level L3 compared to this study (Allaire et al.: AUC (L3) = 0.815; present study: AUC (L3) = 0.663), but revealed a lower AUC compared to the vertebral body we identified as the most reliable predictor for prospective fractures from Th5-L5 (AUC (Th7) = 0.877) [30]
Summary
Osteoporosis is broadly known as a systemic metabolic bone disease, which is accompanied by bone mass decrease and rarefication of the trabecular structure [1]. This disease frequently manifests itself in form of fragility fractures, including the hip and spine as the major sites of fracture occurrence. In Europe total fragility fractures are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23%. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27% [6]
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