Comparison of Vertebral and Femoral Strength Between White and Asian Adults Using Finite Element Analysis of Computed Tomography Scans

Abstract

Given non‐optimal testing rates for dual‐energy X‐ray absorptiometry (DXA) and the high use of computed tomography (CT) in some Asian countries, biomechanical computed tomography analysis (BCT)‐based bone strength testing, which utilizes previously taken clinical CT scans, may improve osteoporosis testing rates. However, an understanding of ethnic differences in such bone strength measurements between Whites and Asians is lacking, which is an obstacle to clinical interpretation. Using previously taken CT and DXA scans, we analyzed bone strength and bone mineral density (BMD) at the hip and spine in two sex‐ and age‐matched community‐based cohorts, aged 40 to 80 years: Whites (Rochester, MN, USA) and Koreans (Seoul, South Korea). For both the spine and femur, the age dependence of bone strength was similar for both groups, White (n = 371; women n = 202, 54.5%) and Korean (n = 396; women n = 199, 50.3%). For both sexes, mean spine strength did not differ between groups, but femur strength was 9% to 14% higher in Whites (p ≤ 0.001), an effect that became non‐significant after weight adjustment (p = 0.375). For Koreans of both sexes, the fragile bone strength thresholds for classifying osteoporosis, when derived from regional DXA BMD T‐score references, equaled the clinically validated thresholds for Whites (in women and men, femoral strength, 3000 N and 3500 N; vertebral strength 4500 N and 6500 N, respectively). Using these thresholds, classifications for osteoporosis for Koreans based on bone strength versus based on DXA BMD T‐scores were consistent (89.1% to 94.4% agreement) at both the hip and spine and for both sexes. The BCT‐based, clinically validated bone strength thresholds for Whites also applied to Koreans, which may facilitate clinical interpretation of CT‐based bone strength measurements for Koreans. © 2020 American Society for Bone and Mineral Research (ASBMR).

Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands

“…3,6,7 This study was conducted in a single National Health Service (NHS) center at Sheffield in the United Kingdom. Similar results have also been shown in studies conducted in other countries, 9 using cohorts of different age, race, and sex. It is worth mentioning that other groups have used BCT to also analyze vertebral fracture.…”

“…It is worth mentioning that other groups have used BCT to also analyze vertebral fracture. 9 However, such analysis has not been done using CT2S. Nevertheless, the question remains as to whether the higher costs associated with measuring the CT2S biomarker would be expected to translate into meaningful health benefits and whether those benefits would be expected to be cost-effective in osteoporosis screening in the Netherlands.…”

Metabolic phenotyping with computed tomography deep learning for metabolic syndrome, osteoporosis and sarcopenia predicts mortality in adults

“…External test cohort 1 was built to test the diagnostic performance of the CT‐based multi‐outcome (MS, osteoporosis and sarcopenia) multi‐layer perceptron (MLP) model trained in the derivation cohort. Data from individuals aged 40–79 who underwent health examinations at Severance Hospital Check‐up Center, Seoul, Korea, between November 2014 and December 2016 were used as the external test cohort 11 . Participants were sampled by age (by decades) and sex strata, with up to 50 participants in a group (total n = 400; Figure and Table ).…”

Letters to the Editor

“…Perhaps more importantly from a public health perspective, the Position Statement omitted to point out that BCT when used clinically typically utilizes a routine CT scan that has been taken previously for other purposes. 3,4,6,[9][10][11][12][13] This means that most patients with a recent CT of the hip or lower spine do not have to undergo any extra procedure to undergo BCT. 8 In terms of possible risk, there is zero radiation exposure associated with BCT when used ''opportunistically'' in this way as the CT has already been taken for other medical indications.…”