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Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients.
Osteoporos Int. 2019 Jun; 30(6):1215-1222.OI

Abstract

INTRODUCTION

Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients.

METHODS

Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results.

RESULTS

This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA.

CONCLUSION

CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk.

Authors+Show Affiliations

Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France. julia@perrier-cornet.fr.Inserm, CIC-1433 Clinical Epidemiology, University Hospital of Nancy, Nancy, France.Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France.Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France.Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

30868182

Citation

Perrier-Cornet, J, et al. "Opportunistic Screening for Osteoporosis Using Thoraco-abdomino-pelvic CT-scan Assessing the Vertebral Density in Rheumatoid Arthritis Patients." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 30, no. 6, 2019, pp. 1215-1222.
Perrier-Cornet J, Omorou AY, Fauny M, et al. Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporos Int. 2019;30(6):1215-1222.
Perrier-Cornet, J., Omorou, A. Y., Fauny, M., Loeuille, D., & Chary-Valckenaere, I. (2019). Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(6), 1215-1222. https://doi.org/10.1007/s00198-019-04931-w
Perrier-Cornet J, et al. Opportunistic Screening for Osteoporosis Using Thoraco-abdomino-pelvic CT-scan Assessing the Vertebral Density in Rheumatoid Arthritis Patients. Osteoporos Int. 2019;30(6):1215-1222. PubMed PMID: 30868182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. AU - Perrier-Cornet,J, AU - Omorou,A Y, AU - Fauny,M, AU - Loeuille,D, AU - Chary-Valckenaere,I, Y1 - 2019/03/13/ PY - 2018/07/25/received PY - 2019/03/04/accepted PY - 2019/3/15/pubmed PY - 2020/1/7/medline PY - 2019/3/15/entrez KW - Bone mineral density KW - CT-attenuation KW - DXA KW - Osteoporosis KW - Rheumatoid arthritis SP - 1215 EP - 1222 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 - 30 IS - 6 N2 - INTRODUCTION: Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients. METHODS: Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results. RESULTS: This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA. CONCLUSION: CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/30868182/Opportunistic_screening_for_osteoporosis_using_thoraco_abdomino_pelvic_CT_scan_assessing_the_vertebral_density_in_rheumatoid_arthritis_patients_ L2 - https://doi.org/10.1007/s00198-019-04931-w DB - PRIME DP - Unbound Medicine ER -