Abstract
ABSTRACTOpportunistic screening for osteoporosis can be performed using low‐dose computed tomography (LDCT) imaging obtained for other clinical indications. In this study we explored the CT‐derived bone mineral density (BMD) and prevalence of osteoporosis from thoracic LDCT in a large population cohort of Chinese men and women. A total of 69,095 adults (40,733 men and 28,362 women) received a thoracic LDCT scan for the purpose of lung cancer screening between 2018 and 2019, and data were obtained for analysis from the China Biobank Project, a prospective nationwide multicenter population study. Lumbar spine (L1–L2) trabecular volumetric bone mineral density (vBMD) was derived from these scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis were applied. Geographic regional differences in the prevalence of osteoporosis were assessed and the age‐standardized, population prevalence of osteoporosis in Chinese men and women was estimated from the 2010 China census. The prevalence of osteoporosis by QCT for the Chinese population aged >50 years was 29.0% for women and 13.5% for men, equating to 49.0 million and 22.8 million, respectively. In women, this rate is comparable to estimates from dual‐energy X‐ray absorptiometry (DXA), but in men, the prevalence is double. Prevalence varied geographically across China, with higher rates in the southwest and lower rates in the northeast. Trabecular vBMD decreased with age in both men and women. Women had higher peak trabecular vBMD (185.4 mg/cm3) than men (176.6 mg/cm3) at age 30 to 34 years, but older women had lower trabecular vBMD (62.4 mg/cm3) than men (92.1 mg/cm3) at age 80 years. We show that LDCT‐based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..
Highlights
The prevalence of osteoporosis and the incidence of fragility fracture in China have increased markedly over the last three decades.[1]
In this large population multicenter study of 69,095 Chinese adults, we show the clinical utility and feasibility of the opportunistic use of low-dose chest CT scans obtained for lung cancer investigations to identify patients with low lumbar spine volumetric bone mineral density (vBMD)
These age-standardized estimates are similar to prevalence data from dual-energy X-ray absorptiometry (DXA) in women, but double that reported in men.[2] we report geographical variation in vBMD and osteoporosis for Chinese women
Summary
The prevalence of osteoporosis and the incidence of fragility fracture in China have increased markedly over the last three decades.[1]. As such, this method could be applied to expand population screening of osteoporosis, in countries or localities where access to dual-energy X-ray absorptiometry (DXA) is limited. DXA-derived areal BMD (aBMD) is required for osteoporosis diagnosis using the World Health Organization criteria, trabecular volumetric BMD (vBMD) derived from CT can be used for diagnosis based on thresholds published by the American College of Radiology of 120 mg/cm and 80 mg/cm to define osteopenia and osteoporosis, respectively, thresholds that were subsequently confirmed for the Chinese population.[7,8,9,10] vBMD appears to be more strongly related to fracture risk than DXA aBMD measures.[11,12]
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