Hounsfield Units for Assessing Bone Mineral Density and Strength: A Tool for Osteoporosis Management

Schreiber, Joseph J.; Anderson, Paul A.; Rosas, Humberto G.; Buchholz, Avery L.; Au, Anthony G.

doi:10.2106/jbjs.j.00160

Cited by 652 publications

(670 citation statements)

References 15 publications

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“…First, we used CTderived HU to estimate the degree of BMD reduction. Although the gold standard for measuring BMD is the DEXA scan, several studies demonstrate the utility of diagnostic CT scan in providing reliable estimates for regional bone strength and BMD [10][11][12][13]. Secondly, this study is a retrospective review of patients treated at a single institution.…”

Section: Discussionmentioning

confidence: 99%

“…Although dual-energy X-ray absorptiometry (DEXA) serves as the gold standard for BMD quantification, several studies have determined that the BMD provided by DEXA has a strong correlation with CT-derived Hounsfield units (HU), can provide reliable estimates for regional bone strength and BMD, and accurately rule out osteoporosis with better than 90% sensitivity [10][11][12][13]. Since diagnostic CT scans are ordered routinely to monitor response to treatments, we can utilize CT-derived HU to monitor BMD in patients, while avoiding the need for additional DEXA imaging and improving resource utilization.…”

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confidence: 99%

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Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

Wei

Jung

Manzano

et al. 2016

Radiotherapy and Oncology

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a b s t r a c tPurpose: To investigate the relationship between abdominal chemoradiation (CRT) for locally advanced cancers and bone mineral density (BMD) reduction in the vertebral spine. Materials and methods: Data from 272 patients who underwent abdominal radiation therapy from January 1997 to May 2015 were retrospectively reviewed. Forty-two patients received computed tomography (CT) scans of the abdomen prior to initiation and at least twice after radiation therapy. Bone attenuation (in Hounsfield unit) (HU) measurements were collected for each vertebral level from T7 to L5 using sagittal CT images. Radiation point dose was obtained at each mid-vertebral body from the radiation treatment plan. Percent change in bone attenuation (D%HU) between baseline and post-radiation therapy were computed for each vertebral body. The D%HU was compared against radiation dose using Pearson's linear correlation. Results: Abdominal radiotherapy caused significant reduction in vertebral BMD as measured by HU. Patients who received only chemotherapy did not show changes in their BMD in this study. The D%HU was significantly correlated with the radiation point dose to the vertebral body (R = À0.472, P < 0.001) within 4-8 months following RT. The same relationship persisted in subsequent follow up scans 9 months following RT (R = À0.578, P < 0.001). Based on the result of linear regression, 5 Gy, 15 Gy, 25 Gy, 35 Gy, and 45 Gy caused 21.7%, 31.1%, 40.5%, 49.9%, and 59.3% decrease in HU following RT, respectively. Our generalized linear model showed that pre-RT HU had a positive effect (b = 0.830) on determining post-RT HU, while number of months post RT (b = À0.213) and radiation point dose (b = À1.475) had a negative effect. A comparison of the predicted versus actual HU showed significant correlation (R = 0.883, P < 0.001) with the slope of the best linear fit = 0.81. Our model's predicted HU were within ±20 HU of the actual value in 53% of cases, 70% of the predictions were within ±30 HU, 81% were within ±40 HU, and 90% were within ±50 HU of the actual post-RT HU. Four of 42 patients were found to have vertebral body compression fractures in the field of radiation. Vertebral body insufficiency and compression fractures are most commonly caused by osteoporosis, an age-related and systemic skeletal disorder characterized by compromised bone strength and low bone mineral density [1]. Although, most fractures are asymptomatic, the degree of BMD loss, location of the fracture, and secondary osteoporosis from underlying medical condition including chemotherapy may make an asymptomatic, stable fracture more prone to progressive collapse causing pain, loss of mobility, and spinal cord compression [2]. The overall morbidity of vertebral body compression fractures is significant, and women diagnosed with compression fractures have a 15% higher mortality rate than matched controls [3].Irradiation of normal, non-malignant bone results in small vessel damage leading to microcirculatory occlusion, marrow hypocellularity from death of osteo...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

Wei

Jung

Manzano

et al. 2016

Radiotherapy and Oncology

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“…In dentistry CT is still used to evaluate the alveolar bone before implant placement, and the HU values are considered to give the objective and reliable information on the amount and quality of bone [6,7] compared to the subjective in its nature classification system of Lekholm and Zarb [8,9] The increasing application of CBCT to bone density assessment impelled researchers to evaluate the new system in relation to CT. Some studies showed that bone density measurements of the same selected regions in jaws made by means of both methods were not corresponding to each other [10,11] displaying higher HU values for CBCT images [8,10].…”

mentioning

confidence: 99%

Evaluating Maxilla Bone Quality Through Clinical Investigation of Voxel Grey Scale Values from Cone-Beam Computed Tomography for Dental Use

Andruch¹,

Płachta²

2015

Adv Clin Exp Med

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“…This measure has been shown to be an accurate and reproducible estimate of bone mineral density, and compares favourably to either dual x-ray absorptiometry or to mechanical testing of subchondral bone strength [15,16,17,22,26].…”

Section: Methodsmentioning

confidence: 96%

Does the relative density of periarticular bone influence the failure pattern of intra-articular fractures?

Tetsworth

Borshch

Dlaska

et al. 2016

Injury

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Hounsfield Units for Assessing Bone Mineral Density and Strength: A Tool for Osteoporosis Management

Cited by 652 publications

References 15 publications

Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

Bone mineral density loss in thoracic and lumbar vertebrae following radiation for abdominal cancers

Evaluating Maxilla Bone Quality Through Clinical Investigation of Voxel Grey Scale Values from Cone-Beam Computed Tomography for Dental Use

Does the relative density of periarticular bone influence the failure pattern of intra-articular fractures?

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