The Use of Computed Tomography Attenuation to Evaluate Osteoporosis Following Acute Fractures of the Thoracic and Lumbar Vertebra

Emohare, Osa; Cagan, Amanda; Morgan, Robert; Davis, Rick; Asis, Martin; Switzer, Julie A.; Polly, David W.

doi:10.1177/2151458514525042

Cited by 42 publications

(33 citation statements)

References 21 publications

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“…We have shown that opportunistic CT scans can be employed to evaluate sacral CT attenuation. Prior works show lumbar CT attenuation can predict lumbar BMD, 11,13,14,16,18 and as we have shown that sacral attenuation values correlate strongly with lumbar attenuation values, we therefore infer that sacral CT attenuation values predict sacral BMD. Topographic variations in sacral BMD identified by this method match the relationships found in prior quantitative CT studies.…”

Section: Resultssupporting

confidence: 73%

“…This study also does not include DXA measurements for evaluation of BMD, instead relying upon previous works which showed correlations between lumbar CT‐attenuation and lumbar BMD as evaluated by DXA. However, prior authors have noted that DXA has limitations, with some theorizing that CT‐based evaluation may be a better measure of true bone mineral density . DXA measures areal BMD (aBMD), which is a 2‐dimensional estimation of the actual 3‐dimensional BMD which can be measured via CT scans.…”

Section: Discussionmentioning

confidence: 99%

“…However, prior authors have noted that DXA has limitations, with some theorizing that CT-based evaluation may be a better measure of true bone mineral density. 11,13,29,30 DXA measures areal BMD (aBMD), which is a 2-dimensional estimation of the actual 3-dimensional BMD which can be measured via CT scans. Unfortunately, this study was not sufficiently powered to be able to establish normative values, which therefore limits the ability to clinically apply this method to evaluate individual patients' sacral BMD.…”

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

“…Recent studies have shown that cancellous bone computed tomography (CT) attenuation values which correlate with DXA measurements of BMD can be obtained at the L1 vertebra using opportunistic CT scans. [11][12][13][14][15][16][17][18][19] No prior studies have examined sacral BMD using this method. As there are 62 million CT scans performed in the United States every year, a substantial proportion of patients undergoing sacroiliac or lumbosacral fixation will have had prior CT scans.…”

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confidence: 99%

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Sacral bone mineral density (BMD) assessment using opportunistic CT scans

Hoel

Ledonio

Takahashi

et al. 2016

Journal Orthopaedic Research

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This study seeks to establish a method for opportunistic evaluation of sacral bone mineral density. This is a retrospective review of 109 scans from 109 patients who had renal-protocol computed tomography (CT) scans performed for any indication during a 3-month period at a single academic institution in 2014. In the collected CT scans, sacral CT-attenuation in multiple regions of interest (ROI) was compared to the L1 CT-attenuation, an internal reference standard, to determine if a correlation existed. The sacral ROI were analyzed to determine regions of higher and lower attenuation. All sacral ROI had strong correlations with lumbar spine attenuation values, and these values became even stronger when transitional vertebrae were excluded. Sacral attenuation values varied predictably by location, and matched relationships were shown by prior volumetric bone mineral density studies. We conclude that sacral CT-attenuation can be used in opportunistic CT scans to determine sacral bone mineral density. Keywords: bone mineral density; BMD; sacral; sacrum; computed tomography; CT; sacroiliac fixation; lumbosacral fixation Sacroiliac (SI) joint pain is increasingly being recognized as a common lower back pain generator. Prior studies have estimated approximately 15-25% of low back pain comes from the SI joint. [1][2][3][4][5] To address this pathology, sacroiliac fusion techniques are gaining increased attention. 6 These procedures rely upon fixation across the SI joint. 7 Sacral sided loosening appears to be the most common mode of failure, likely due to poor bone quality in that region of the sacrum (Fig. 1).Sacral bone density has previously been studied in relation to lumbosacral fusion. Prior studies have shown up to 45% of sacropelvic instrumentation failures have S1 screw haloing or pullout, with biomechanical studies showing sacral screw pullout strength is weaker in low sacral bone mineral density (BMD). 8,9 Unfortunately, over 50% of females and 15% of males requiring spine surgery after the age of 50 are osteoporotic as evaluated by dual-energy X-ray absorptiometry (DXA). 10 With such high incidence of osteoporosis in this population, further studies are needed to quantify the risk of unsuccessful SI and lumbosacral fixation and fusion with relation to sacral BMD. Development of an accessible method for evaluation of sacral bone density would be instrumental in determining the relation of bone density to successful SI joint and lumbosacral fixation and fusion.Recent studies have shown that cancellous bone computed tomography (CT) attenuation values which correlate with DXA measurements of BMD can be obtained at the L1 vertebra using opportunistic CT scans. [11][12][13][14][15][16][17][18][19] No prior studies have examined sacral BMD using this method. As there are 62 million CT scans performed in the United States every year, a substantial proportion of patients undergoing sacroiliac or lumbosacral fixation will have had prior CT scans. 20 If sacral BMD was able to be assessed from prior CT scans, ...

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Section: Resultssupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Sacral bone mineral density (BMD) assessment using opportunistic CT scans

Hoel

Ledonio

Takahashi

et al. 2016

Journal Orthopaedic Research

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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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