Femoral Neck Hounsfield Units as an Adjunct for Bone Mineral Density After Combat-Related Lower Extremity Amputation

Hoyt, Benjamin W.; Lundy, Alex E; Clark, Damian; Colantonio, Donald F.; Tintle, Scott M.; Potter, Benjamin K.

doi:10.1097/bot.0000000000001980

Cited by 6 publications

(9 citation statements)

References 40 publications

(68 reference statements)

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“…Our study neutralized these deficiencies. We controlled the interval time to 6 months, enrolled 680 patients, and further proved the positive correlation between the proximal femur CT HU value and femoral neck T‐score, which was consistent with the previous study 22,28 …”

Section: Discussionsupporting

confidence: 86%

“…In Christiansen's 22 study, the number of osteoporosis patients was not enough to identify the cutoff value of osteoporosis, but the mean proximal femur CT HU value in his study was 56 ± 29 HU, which was roughly consistent with our cutoff value. In Benjamin's 28 study, the cutoff value for osteoporosis was higher (98 HU) than that in our study. The main reason for this difference may be that the patients enrolled in his study were mainly young people with a mean age of 26.4 years old, and the amputation condition could have a great impact on the total body bone quality, which was not suitable for comparison with normal patients.…”

Section: Discussioncontrasting

confidence: 78%

“…In Christiansen's 22 study, the number of patients with interval times less than 6 months was only 69, and the small sample size could also produce statistical bias. Indeed, Benjamin et al 28 limited the interval time to 6 months and proved the good positive correlation between the proximal femur CT HU value and DXA results, but the samples were also small, and the target population was amputated patients and not common patients. Our study was able to make up for these two shortcomings.…”

Section: Discussionmentioning

confidence: 99%

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Positive correlation between the proximal femur Hounsfield units from routine CT and DXA results

Yang

Xing

Zou

et al. 2023

Journal Orthopaedic Research

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To determinate the correlation between the proximal femur Hounsfield unit (HU) value and dual‐energy X‐ray absorptiometry (DXA) results, and to identify its feasibility for opportunistic screening osteoporosis. A total of 680 patients underwent computed tomography (CT) containing proximal femur and DXA test within 6 months between 2010 and 2020 in our hospital. The CT HU value of four axial slices of the proximal femur were measured. The measurements were compared with the DXA results by Pearson correlation coefficient. Receiver operator characteristic curve were generated to identify the best cutoff for diagnosing osteoporosis. These 680 consecutive patients included 165 male and 515 female; the average age was 63.66 ± 11.36 years old, the mean interval time between two examinations was 45.43 days. The most representative CT HU value measurement was the 5‐mm slice measurement. The average CT HU value was 59.3 ± 36.5 HU, and the differences among the three DXA defined bone mineral density (BMD) categories were significant (all p < 0.001). The Pearson correlation analysis showed that the proximal femur CT values had strong positive correlation with femoral neck T‐score, femoral neck BMD and total hip BMD (r = 0.777, r = 0.748, r = 0.746, respectively; all p < 0.001). The area under the curve for CT value for diagnosing osteoporosis was 0.893 (p < 0.001), the best cutoff was 67 HU with 84% sensitivity, 80% specificity, 92% positive predictive value and 65% negative predictive value. Proximal femur CT values had good positive correlation with DXA results, which could be used to opportunistic screening for potential osteoporosis patient.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Positive correlation between the proximal femur Hounsfield units from routine CT and DXA results

Yang

Xing

Zou

et al. 2023

Journal Orthopaedic Research

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“…In a previous study 17 , we determined that HU measurements from CT imaging, performed as part of injury work-up, healing assessment, and evaluation of complications or other findings, may be used to opportunistically assess BMD and screen for low BMD after lower extremity amputation. This CT-based HU-cBMD technique and similar techniques have been validated for low-BMD screening in other patient populations [18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

“…Previously, our group determined that this measurement could be reliably used to estimate DXA T-scores and to determine low BMD, defined as density less than or equal to the threshold for osteopenia (T-score £21.0). With use of the T-score thresholds for osteopenia and osteoporosis, the low BMD group was considered to include those with a femoral neck HU value of <151 and the osteoporosis group was considered to include those with a femoral neck HU value of <98 17 . We opted to use T-scores rather than Z-scores because the standardized patient reference point for T-scores (healthy 30-year-old males) would prevent changes in HU-cBMD accuracy in association with patient age and also because of the established clinical utility of T-scores.…”

Section: Methodsmentioning

confidence: 99%

Hounsfield Unit-Calculated Bone Mineral Density Loss Following Combat-Related Lower Extremity Amputations

Hoyt,

Lundy,

Colantonio

et al. 2023

Journal of Bone and Joint Surgery

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Background: After combat-related lower extremity amputations, patients rapidly lose bone mineral density (BMD). As serial dual x-ray absorptiometry (DXA) scans are rarely performed in this setting, it is difficult to determine the timeline for bone loss and recovery or the role of interventions. However, a strong correlation has been demonstrated between DXA BMD and computed tomography (CT) signal attenuation. We sought to leverage multiple CT scans obtained after trauma to develop a predictive model for BMD after combat-related lower extremity amputations. Methods: We reviewed amputations performed within the United States military between 2003 and 2016 in patients with multiple CT scans. We collected pertinent clinical information, including amputation level(s), complications, and time to weight-bearing. The primary outcome measure was the development of low BMD, estimated in Hounsfield units (HU) from CT scans with use of a previously validated method. One hundred and twenty-eight patients with 613 femoral neck CT scans were available for analysis. A least absolute shrinkage and selection operator (LASSO) multiple logistic regression analysis was applied to determine the effects of modifiable and non-modifiable variables on BMD. A random-effects model was applied to determine which factors were most predictive of low BMD and to quantify their effects. Results: Both amputated and non-amputated extremities demonstrated substantial BMD loss, which stabilized approximately 3 years after the injury. Loss of BMD followed a logarithmic pattern, stabilizing after 1,000 days. On average, amputated limbs lost approximately 100 HU of BMD after 1,000 days. Other factors identified by the mixed-effects model included nonambulatory status (−33.5 HU), age at injury (−3.4 HU per year), surgical complications delaying weight-bearing (−21.3 HU), transtibial amputation (20.9 HU), and active vitamin-D treatment (−19.7 HU). Conclusions: Patients with combat-related lower extremity amputations experience an initially rapid decline in BMD in both intact and amputated limbs as a result of both modifiable and non-modifiable influences, including time to walking, amputation level, surgical complications, and age. The paradoxical association of vitamin-D supplementation with lower HU likely reflects this treatment being assigned to patients with low BMD. This model may assist with clinical decision-making prior to performing lower extremity amputation and also may assist providers with postoperative decision-making to optimize management for prophylaxis against osteoporosis. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Performance of calcium quantifications on low-dose photon-counting detector CT with high-pitch: A phantom study

Zhou,

Liu,

Dong

et al. 2024

Heliyon

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Femoral Neck Hounsfield Units as an Adjunct for Bone Mineral Density After Combat-Related Lower Extremity Amputation

Abstract: Objectives: To correlate femoral neck Hounsfield units (HUs) measured on a computed tomography (CT) scan to dual-energy x-ray absorptiometry (DEXA) T-scores allowing evaluation of bone mineral density (BMD) over time after lower extremity traumarelated amputation.

Cited by 6 publications

References 40 publications

Positive correlation between the proximal femur Hounsfield units from routine CT and DXA results

Positive correlation between the proximal femur Hounsfield units from routine CT and DXA results

Hounsfield Unit-Calculated Bone Mineral Density Loss Following Combat-Related Lower Extremity Amputations

Performance of calcium quantifications on low-dose photon-counting detector CT with high-pitch: A phantom study

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