Abstract
PurposeTo assess whether volumetric vertebral bone mineral density (BMD) measured with opportunistic quantitative computed tomography (QCT) (i.e., CT acquired for other reasons) can predict osteoporotic fracture occurrence in a prospective clinical cohort and how this performs in comparison to dual-energy X-ray absorptiometry (DXA) measurements.MethodsIn the database of our fracture liaison service, 58 patients (73 ± 11 years, 72% women) were identified that had at least one prevalent low-energy fracture and had undergone CT of the spine. BMD was determined by converting HU using scanner-specific conversion equations. Baseline DXA was available for 31 patients. During a 3-year follow-up, new fractures were diagnosed either by (i) recent in-house imaging or (ii) clinical follow-up with validated external reports. Associations were assessed using logistic regression models, and cut-off values were determined with ROC/Youden analyses.ResultsWithin 3 years, 20 of 58 patients presented new low-energy fractures (34%). Mean QCT BMD of patients with fractures was significantly lower (56 ± 20 vs. 91 ± 38 mg/cm3; p = 0.003) and age was higher (77 ± 10 vs. 71 ± 11 years; p = 0.037). QCT BMD was significantly associated with the occurrence of new fractures, and the OR for developing a new fracture during follow-up was 1.034 (95% CI, 1.010–1.058, p = 0.005), suggesting 3% higher odds for every unit of BMD decrease (1 mg/cm3). Age and sex showed no association. For the differentiation between patients with and without new fractures, ROC showed an AUC of 0.76 and a Youden’s Index of J = 0.48, suggesting an optimal cut-off value of 82 mg/cm3. DXA T-scores showed no significant association with fracture occurrence in analogous regression models.ConclusionIn this use case, opportunistic BMD measurements attained through QCT predicted fractures during a 3-year follow-up. This suggests that opportunistic measurements are useful to reduce the diagnostic gap and evaluate the fracture risk in osteoporotic patients.
Highlights
Osteoporosis is a metabolic bone disease characterized by an overall reduced bone mass and microarchitectural deterioration of the bone tissue leading to reduced bone strength and lowenergy fractures [1, 2]
We investigated the use of bone mineral density (BMD) measurement by above-mentioned asynchronously calibrated opportunistic quantitative CT (QCT) with regard to risk assessment and predictive value for osteoporotic fractures
Since this study focused on vertebral BMD, only measurements in lumbar vertebrae were considered to ensure comparability to QCT BMD measurements
Summary
Osteoporosis is a metabolic bone disease characterized by an overall reduced bone mass and microarchitectural deterioration of the bone tissue leading to reduced bone strength and lowenergy fractures [1, 2]. Complications such as pain and immobilization are a burden for the patient and for health care and social security systems due to the ensuing financial costs [3]. The detection and assessment of osteoporosis at an early stage and evaluation of the risk for osteoporotic fractures is of high importance. A pillar in this process is accurate imaging of osteoporosis and osteoporotic fractures
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have