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Opportunistic screening for osteoporosis by routine CT in Southern Europe.
Osteoporos Int. 2017 03; 28(3):983-990.OI

Abstract

Feasibility evaluation of early detection of osteoporosis in oncologic patients by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed for other clinical indications, by using dual-energy X-ray absorptiometry (DXA) as reference. Abdominal CT images can identify patients with osteoporosis BMD without additional radiation exposure or cost.

INTRODUCTION

The purpose of the study is to evaluate the feasibility of early detection of osteoporosis by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed in oncologic patients, comparing calibrated and uncalibrated measurements by using dual-energy X-ray absorptiometry (DXA) as reference. We also performed an external validation of a threshold of 160 Hounsfield units (HU), proposed as highly sensitive.

METHODS

Cohort comprised CT-DXA pairs within a 6-month period performed for any indication on 326 consecutive adults, aged 62.4 ± 12.38 years (mean ± standard deviation). CT attenuation of trabecular bone in HU was measured at the axial cross sections of L1, L2, L3, and L4 vertebrae. Vertebral compression fractures were assessed by sagittal reconstruction view. Diagnostic performance measures and the area under the receiver operator characteristic curve (AUC) for diagnosing osteoporosis were calculated.

RESULTS

BMD values were statistical significantly lower at any vertebral level from L1 to L4 for patients with osteoporosis defined by DXA (p < 0.001). Calibrated and uncalibrated BMD values were significantly correlated (R 2 = 0.833, p < 0.01). An uncalibrated L1 CT attenuation threshold of 160 HU was more than 90 % sensitive, and a threshold of 73 HU was more than 90 % specific for distinguishing osteoporosis BMD. Fifty-nine percent of patients with vertebral compression fracture had non-osteoporotic DXA T-scores.

CONCLUSIONS

Abdominal CT images obtained for other reasons can identify patients with osteoporosis BMD without additional radiation exposure or cost. Uncalibrated values at L1 can detect more osteoporosis patients with spinal compression fractures than DXA in oncologic patients.

Authors+Show Affiliations

Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Cami de Vera, s/n, 46022, Valencia, Spain.Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Cami de Vera, s/n, 46022, Valencia, Spain. dmoratal@eln.upv.es.Department of Radiology, Fundación Instituto Valenciano de Oncología, C/ Profesor Beltrán Báguena, 19, 46009, Valencia, Spain. aranae@uv.es.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

28108802

Citation

Alacreu, Elena, et al. "Opportunistic Screening for Osteoporosis By Routine CT in Southern Europe." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 28, no. 3, 2017, pp. 983-990.
Alacreu E, Moratal D, Arana E. Opportunistic screening for osteoporosis by routine CT in Southern Europe. Osteoporos Int. 2017;28(3):983-990.
Alacreu, E., Moratal, D., & Arana, E. (2017). Opportunistic screening for osteoporosis by routine CT in Southern Europe. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 28(3), 983-990. https://doi.org/10.1007/s00198-016-3804-3
Alacreu E, Moratal D, Arana E. Opportunistic Screening for Osteoporosis By Routine CT in Southern Europe. Osteoporos Int. 2017;28(3):983-990. PubMed PMID: 28108802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opportunistic screening for osteoporosis by routine CT in Southern Europe. AU - Alacreu,Elena, AU - Moratal,David, AU - Arana,Estanislao, Y1 - 2017/01/20/ PY - 2016/03/11/received PY - 2016/10/03/accepted PY - 2017/1/22/pubmed PY - 2018/6/5/medline PY - 2017/1/22/entrez KW - Bone density KW - Computed tomography KW - External validation KW - Lumbar vertebrae KW - Osteoporosis KW - Screening KW - Spinal fractures SP - 983 EP - 990 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 28 IS - 3 N2 - : Feasibility evaluation of early detection of osteoporosis in oncologic patients by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed for other clinical indications, by using dual-energy X-ray absorptiometry (DXA) as reference. Abdominal CT images can identify patients with osteoporosis BMD without additional radiation exposure or cost. INTRODUCTION: The purpose of the study is to evaluate the feasibility of early detection of osteoporosis by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed in oncologic patients, comparing calibrated and uncalibrated measurements by using dual-energy X-ray absorptiometry (DXA) as reference. We also performed an external validation of a threshold of 160 Hounsfield units (HU), proposed as highly sensitive. METHODS: Cohort comprised CT-DXA pairs within a 6-month period performed for any indication on 326 consecutive adults, aged 62.4 ± 12.38 years (mean ± standard deviation). CT attenuation of trabecular bone in HU was measured at the axial cross sections of L1, L2, L3, and L4 vertebrae. Vertebral compression fractures were assessed by sagittal reconstruction view. Diagnostic performance measures and the area under the receiver operator characteristic curve (AUC) for diagnosing osteoporosis were calculated. RESULTS: BMD values were statistical significantly lower at any vertebral level from L1 to L4 for patients with osteoporosis defined by DXA (p < 0.001). Calibrated and uncalibrated BMD values were significantly correlated (R 2 = 0.833, p < 0.01). An uncalibrated L1 CT attenuation threshold of 160 HU was more than 90 % sensitive, and a threshold of 73 HU was more than 90 % specific for distinguishing osteoporosis BMD. Fifty-nine percent of patients with vertebral compression fracture had non-osteoporotic DXA T-scores. CONCLUSIONS: Abdominal CT images obtained for other reasons can identify patients with osteoporosis BMD without additional radiation exposure or cost. Uncalibrated values at L1 can detect more osteoporosis patients with spinal compression fractures than DXA in oncologic patients. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/28108802/Opportunistic_screening_for_osteoporosis_by_routine_CT_in_Southern_Europe_ L2 - https://doi.org/10.1007/s00198-016-3804-3 DB - PRIME DP - Unbound Medicine ER -