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Zhang J, Luo X, Zhou R, Guo C, Xu K, Qu G, Zou L, Yao W, Lin S, Zhang Z. The Suitable Population for Opportunistic Low Bone Mineral Density Screening Using Computed Tomography. Clin Interv Aging 2024; 19:807-815. [PMID: 38751857 PMCID: PMC11095516 DOI: 10.2147/cia.s461018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To explore the suitable population of CT value for predicting low bone mineral density (low-BMD). Methods A total of 1268 patients who underwent chest CT examination and DXA within one-month period retrospectively analyzed. The CT attenuation values of trabecular bone were measured in mid-sagittal plane from thoracic vertebra 7 (T7). Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose low-BMD. Results The AUC for diagnosing low BMD was larger in women than in men (0.894 vs 0.744, p < 0.05). The AUC increased gradually with the increase of age but decreased gradually with the increase in height and weight (p < 0.05). In females, when specificity was adjusted to approximately 90%, a threshold of 140.25 HU has a sensitivity of 69.3%, which is higher than the sensitivity of 36.5% in males for distinguishing low-BMD from normal. At the age of 70 or more, when specificity was adjusted to approximately 90%, a threshold of 126.31 HU has a sensitivity of 76.1%, which was higher than that of other age groups. Conclusion For patients who had completed chest CTs, the CT values were more effective in predicting low-BMD in female, elderly, lower height, and lower weight patients.
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Affiliation(s)
- Jiongfeng Zhang
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Xiaohui Luo
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Ruiling Zhou
- Department of Dermatology, Jiangxi Provincial Dermatology Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Chong Guo
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Kai Xu
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Gaoyang Qu
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Le Zou
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Wenye Yao
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Shifan Lin
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
| | - Zhiping Zhang
- Department of Orthopedics, the 3rd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330008, People’s Republic of China
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Wang S, Liu H, Yang K, Zhang X, Hu Y, Yang H, Qu B. The Significance of Combined OSTA, HU Value and VBQ Score in Osteoporosis Screening Before Spinal Surgery. World Neurosurg 2024; 182:e692-e701. [PMID: 38081584 DOI: 10.1016/j.wneu.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE This study aimed to assess the utility of a combined assessment using the Osteoporosis Self-Assessment Tool for Asians (OSTA), Hounsfield unit (HU) value, and vertebral bone quality (VBQ) score for preoperative osteoporosis (OP) screening in patients scheduled for spinal surgery. METHODS This study encompassed 288 participants, including 128 males and 160 females. Patients were stratified into 2 groups: the OP group (T-score ≤ -2.5) and the non-OP group (T-score > -2.5), determined by dual-energy X-ray absorptiometry (DEXA). Binary logistic regression was used to construct a combined diagnostic model, and the receiver operating characteristic (ROC) curve evaluated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these metrics individually or in combination to screen for OP. RESULTS Osteoporosis patients exhibited significantly lower OSTA and HU values in comparison to non-OP patients, while their VBQ scores were significantly higher (P < 0.001). The ROC curve analysis results indicated that within the male group, the combined diagnosis had a sensitivity of 93.8%, specificity of 82.3%, accuracy of 85.2%, PPV of 63.8%, and NPV of 97.5%. In the female group, the combined diagnosis had a sensitivity of 93.9%, specificity of 87.4%, accuracy of 90.0%, PPV of 83.6%, and NPV of 95.4%. CONCLUSIONS The combined use of OSTA, HU values, and VBQ scores in preoperative OP screening for spinal surgery demonstrates significantly higher accuracy and superior screening value compared to individual assessments. These results establish a robust scientific foundation for conducting preoperative OP screening in patients undergoing spinal surgery.
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Affiliation(s)
- Song Wang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Hao Liu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Kunhai Yang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Xiang Zhang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Yongrong Hu
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Hongsheng Yang
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Bo Qu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China.
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Lin J, Guo S, Zuo W, Wu H, Li Y, Yang X, Yang Y, Fei Q. Validation of Three Tools for Estimating the Risk of Primary Osteoporosis in an Elderly Male Population in Beijing. Clin Interv Aging 2023; 18:845-853. [PMID: 37256154 PMCID: PMC10225276 DOI: 10.2147/cia.s410239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose This cross-sectional study estimated three clinical tools including the Osteoporosis Self-Assessment Tool for Asians (OSTA), Body Mass Index (BMI), and Beijing Friendship Hospital Osteoporosis Self-assessment Tool for Elderly Male (BFH-OSTM) for identifying primary osteoporosis and found optimal cut-off values in an elderly Han Beijing male population. Materials and Methods We conducted a cross-sectional study, enrolling 400 community-dwelling elderly Han Beijing males aged ≥50 from 8 medical institutions. Osteoporosis was diagnosed as a T-score of -2.5 standard deviations or lower than that of the average young adult in different diagnostic criteria [lumbar spine (L1-L4), femoral neck, total hip, WHO]. BFH-OSTM, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUC) were determined. Ideal thresholds for the omission of screening BMD were proposed. Results The prevalence of osteoporosis ranged from 9.25% to 19.0% according to different diagnostic criteria. The present study indicated the highest discriminating ability was BFH-OSTM in different criteria. The AUCs of OSTA and BMI were 0.748 and 0.770 in WHO criteria, which suggested limiting predictive value for identifying OP in elderly Beijing males. The AUC of BFH-OSTM to predict OP based on WHO criteria was 0.827, yielding a sensitivity of 65.8% and specificity of 82.7%, respectively. With a cost of missing 6.5% of osteoporosis patients, BFH-OSTM could reduce 73.5% of participants in screening BMD tests. Conclusion BFH-OSTM may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.
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Affiliation(s)
- Jisheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Sijia Guo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiyang Zuo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hao Wu
- Fangzhuang Community Health Service Center, Beijing, People’s Republic of China
| | - Yongjin Li
- Tuanjiehu Community Health Service Center, Beijing, People’s Republic of China
| | - Xiuquan Yang
- Wangzuo Community Health Service Center, Beijing, People’s Republic of China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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