Diagnostic efficacy of routine contrast-enhanced abdominal CT for the assessment of osteoporosis in the Turkish population

Assessment of trabecular bone Hounsfield units in the lumbar spine for osteoporosis evaluation in individuals aged 65 and above: a review

Osteoporosis is a prevalent condition that significantly increases fracture risk, particularly in the elderly population. Despite its widespread occurrence, osteoporosis is often underdiagnosed and inadequately managed. Traditional diagnostic methods, such as dual-energy X-ray absorptiometry (DXA), have limitations in terms of accessibility and accuracy, necessitating exploration of alternative diagnostic approaches.This review aims to evaluate the diagnostic potential of Hounsfield Unit (HU) values derived from abdominal computed tomography (CT) scans, specifically focusing on the trabecular bone of the lumbar spine, for osteoporosis assessment in individuals aged 65 and older. The review seeks to assess the sensitivity, specificity, and overall diagnostic performance of HU values in distinguishing between normal bone density, osteopenia, and osteoporosis, and to identify areas for further investigation to establish standardized diagnostic criteria.This review compiles existing studies on the use of HU values from abdominal CT scans for osteoporosis diagnosis. It examines the relationship between HU values and DXA T-scores, analyzes optimal HU thresholds for classifying bone density categories, and explores the potential of CT scans as a viable alternative to DXA.The findings indicate that HU values from abdominal CT scans show strong correlations with DXA T-scores, suggesting a promising diagnostic tool for assessing bone density and quality. HU values have demonstrated the ability to differentiate between osteopenia, osteoporosis, and normal bone density, with varying sensitivity and specificity depending on the established HU threshold. CT scans are identified as a scalable, cost-effective alternative to DXA, with the added benefit of utilizing routine abdominal CT scans, which are often conducted for other clinical reasons, thereby reducing additional costs and radiation exposure.HU values derived from abdominal CT scans represent a promising approach for osteoporosis screening, offering a potential solution for routine, cost-effective, and accurate diagnosis, especially in older adults. However, there is a need for standardized HU thresholds and further research to refine diagnostic criteria and enhance the accuracy of osteoporosis detection. Establishing standardized guidelines would improve diagnostic consistency and facilitate early intervention, potentially improving patient outcomes and reducing healthcare burdens.

The Impact of Contrast Media on Lumbar Spine Bone Mineral Density Measured by Quantitative Computed Tomography

Background

Osteoporosis is a bone disease caused by decrease in bone mineral density (BMD). Quantitative computed tomography (QCT) has proven to be an effective tool to measure the BMD of the lumbar spine. Therefore, the objective of the study is to investigate the impact of intravenous contrast media (CM) on BMD of lumbar spine measured by QCT.

Methods

This is a prospective study and included a total of 141 patients (females: 71, males: 70) referred for contrast enhanced computed tomography (CECT) abdomen. First, the plain scan of abdomen was done. Contrast media was injected intravenously followed by acquisition of arterial and portovenous phase (PV) of abdomen. Plain, arterial and PV phases axial CT images were loaded on Philips BMD analysis application. A circular region of interest (ROI) measuring 30-40 mm2 was placed at all five lumbar vertebrae (L1-L5) and value of BMD was obtained in mg/cm3.

Results

Paired t-test was used to compare BMD in plain, arterial and PV phase. There was significant difference (p <0.05) in BMD (L1-L5) between plain (110.86±36.61 mg/cm3), arterial (117.04±37.95 mg/cm3) and PV phase (127.52±40.9 mg/cm3). The study also noted significant difference between males and females in BMD of lumbar spine (L1-L5) for plain and CECT abdomen (p <0.05).

Conclusion

The BMD was highest for PV phase of the CECT abdomen. Therefore, the study concludes that BMD values are highly influenced by intravenous contrast media injections.

Effect of osteosarcopenia on the development of a second compression fracture and mortality in elderly patients after vertebroplasty

OBJECTIVE

This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compression fracture (OVCF).

METHODS

A retrospective evaluation was conducted on 104 patients treated by vertebroplasty because of OVF between 2016 and 2021. The L3 vertebra Hounsfield unit values and the psoas muscle index (PMI) values measured at the L3 vertebra level were obtained from the patients' medical data and computed tomography images. Using these measurements, the patients were divided into 3 groups: only osteoporosis (OO group), only sarcopenia (OS group), and osteosarcopenia (OSP group). Differences between the groups were evaluated regarding second OVCF development and mortality.

RESULTS

The study included 104 patients, comprising 30 males and 74 females aged 60-92 years. The OS group included 10 patients, the OO group included 54 patients, and the OSP group consisted of 40 patients. A single vertebral fracture occurred in 72 patients, and 2 vertebral fractures occurred in 32 patients. The chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Kaplan-Meier survival analysis results showed no statistically significant difference between the 3 groups for the risk of second vertebral fracture. Sarcopenia, either alone or in combination with osteoporosis, was seen to have a negative effect on the survival of patients who underwent vertebro- plasty following a vertebral fracture.

CONCLUSION

This study has shown that osteosarcopenia did not increase the risk of developing a second vertebral fracture, but it increased mortality 2.8-fold for those who underwent vertebroplasty after vertebral fracture.

LEVEL OF EVIDENCE

Level III, Prognostic study.