Abstract:

Osteoporosis and osteopenia are one of the significant public health problems due to related low bone mineral density (BMD) and increased risk of fracture. Dual X-Ray Absorptiometry (DXA) is considered the gold standard for BMD assessment but is limited in availability and cannot assess bone microachitecture. This study assessed the diagnostic performance of Computed Tomography (CT) against DXA based on sensitivity, specificity and interrater reliability. This prospective study was done over 12 months in a tertiary health care hospital in Chennai which included 128 adult patients who underwent routine CT Abdomen and Pelvis for unrelated conditions. CT-derived Hounsfield Unit (HU) measurements were compared with T-scores from DXA. Sensitivity, Specificity and interrater reliability (Intraclass Correlation Coefficient, ICC) were calculated. Statistical methods included Pearson correlation and linear regression analysis. CT had a sensitivity of 0.88 and specificity of 0.92 for identifying osteoporosis, while DXA had a sensitivity of 0.85 and specificity of 0.90 when compared to CT. For osteopenia, CT was also more sensitive (0.78) and specific (0.85) than DXA (0.75 and 0.80, respectively) The interrater reliability of radiologists interpreting CT scans was strong, with intraclass correlation coefficient (ICC) of 0.92 for osteoporosis and 0.85 for osteopenia. A significant positive correlation (r = 0.75, p < 0.05) was found between HU values and BMDCT provides a reliable alternative to DXA for pathologic identification of osteoporosis and osteopenia, with high sensitivity, specificity and reproducibility. Opportunistic supplementation of HU values during routine CT scans is easy to perform in practice, and provides a tool for detecting individuals at high risk for metabolic bone disease.

References:

[1]. Pirayesh Islamian, J., Garoosi, I., Abdollahi Fard, K., Abdollahi, M. R., 2016, Comparison between the MDCT and the DXA scanners in the evaluation of BMD in the lumbar spine densitometry, The Egyptian Journal of Radiology and Nuclear Medicine, vol. 47, no. 3, pp. 961–967. doi: 10.1016/j.ejrnm.2016.04.005

[2]. Chia, K. K., Haron, J., Nik Malek, N. F. S., 2021, Accuracy of computed tomography attenuation value of lumbar vertebra to assess bone mineral density, Malaysian Journal of Medical Sciences, vol. 28, no. 1, pp. 41–50.

[3]. Pu, H., Chen, Q., Huang, K., Wei, P., Jiang, P., Zhang, C., 2022, Correlation between wrist bone mineral density measured by dual-energy X-ray absorptiometry and Hounsfield units value measured by CT in Lumbar spine, Research Square, doi:10.21203/rs.3.rs-1540685/v1

[4]. Genant, H. K., Cooper, C., Poor, G., Reid, I., Ehrlich, G., Kanis, J., et al., 1999, Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis, Osteoporosis International, vol. 10, no. 4, pp. 259–264.

[5]. Sözen, T., Özışık, L., Başaran, N.Ç., 2017, An overview and management of osteoporosis, European Journal of Rheumatology, vol. 4, no. 1, pp. 46–56.

[6]. Black, D. M., Rosen, C. J., 2016, Clinical Practice. Postmenopausal Osteoporosis, New England Journal of Medicine, vol. 374, no. 3, pp. 254–262.

[7]. Butera, A., Maiorani, C., Gallo, S., Pascadopoli, M., Venugopal, A., Marya, A., Scribante, A., 2022, Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review, Healthcare (Basel), vol. 10, no. 5, pp. 886. doi:10.3390/healthcare10050886

[8]. Link, T. M., 2012, Osteoporosis Imaging: State of the Art and Advanced Imaging, Radiology, vol. 263, no. 1, pp. 3–17.

[9]. Engelke, K., Adams, J. E., Armbrecht, G., Augat, P., Bogado, C. E., Bouxsein, M. L., et al., 2008, Clinical Use of Quantitative Computed Tomography and Peripheral Quantitative Computed Tomography in the Management of Osteoporosis in Adults: The 2007 ISCD Official Positions, Journal of Clinical Densitometry, vol. 11, no. 1, pp. 123–162.

[10]. Krueger, D., Fidler, J. L., Perkinson, B. C., Binkley, N., 1994, Dual-Energy X-ray Absorptiometry of the Lumbar Spine: Theoretical Principles and In Vivo Performance of the Norland Apollo Densitometer, Journal of Bone and Mineral Research, vol. 9, no. 9, pp. 1411–1422.

[11]. Silva, B. C., Broy, S. B., Boutroy, S., Schousboe, J. T., Shepherd, J. A., Leslie, W. D., 2015, Fracture Risk Prediction by Non-BMD DXA Measures: The 2015 ISCD Official Positions Part 2: Trabecular Bone Score, Journal of Clinical Densitometry, vol. 18, no. 3, pp. 309–330.

[12]. Senkutvan, R. S., Jacob, S., Charles, A., Vadgaonkar, V., Jatol-Tekade, S., Gangurde, P., 2014, Evaluation of nickel ion release from various orthodontic arch wires: An in vitro study, Journal of International Society of Preventive & Community Dentistry, vol. 4, no. 1, pp. 12–16. doi:10.4103/2231-0762.130921

[13]. Cody, D. D., Gross, G. J., Hou, F. J., Spencer, H. J., Goldstein, S. A., Fyhrie, D. P., 1999, Femoral Strength is Better Predicted by Finite Element Models than QCT and DXA, Journal of Biomechanics, vol. 32, no. 10, pp. 1013–1020.

[14]. Baum, T., Müller, D., Dobritz, M., Rummeny, E. J., Link, T. M., Bauer, J. S., 2013, BMD Measurements of the Spine Derived from Sagittal Reformations of Contrast-Enhanced MDCT Without Dedicated Software, European Journal of Radiology, vol. 82, no. 2, pp. e80–e86.

[15]. Boutroy, S., Bouxsein, M. L., Munoz, F., Delmas, P. D., 2005, In Vivo Assessment of Trabecular Bone Microarchitecture by High-Resolution Peripheral Quantitative Computed Tomography, Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 12, pp. 6508–6515.

[16]. Schwaiger, B. J., Gersing, A. S., Kopp, F. K., et al., 2019, Diagnostic Value of Routine Chest CT for Detection of Osteoporosis and Vertebral Fractures in Patients with Lung Cancer, European Journal of Radiology, vol. 110, pp. 50–55.

[17]. Faulkner, K., Moores, B. M., 2000, The Relationship Between Age, Sex, and the Effective Dose from DXA Scans, Physics in Medicine and Biology, vol. 45, no. 9, pp. 2531–2540. doi:10.1088/0031-9155/45/9/318

[18]. Vaid, N. R., Sabouni, W., Wilmes, B., Bichu, Y. M., Thakkar, D. P., Adel, S. M., 2022, Customized adjuncts with clear aligner therapy: “The Golden Circle Model” explained, Journal of the World Federation of Orthodontists, vol. 11, no. 6, pp. 216–225. doi:10.1016/j.ejwf.2022.10.005

[19]. Kanis, J. A., Borgström, F., Compston, J., et al., 2020, SCOPE: A Scorecard for Osteoporosis in Europe, Archives of Osteoporosis, vol. 15, no. 1, p. 172. doi:10.1007/s11657-020-00857-6

[20]. Messina, C., Bignotti, B., Codella, U., et al., 2021, Evaluation of Bone Mineral Density by DXA and HR-pQCT in Males with Isolated Hypogonadotropic Hypogonadism at Baseline and After 18 Months of Androgen Replacement, Clinical Endocrinology (Oxford), vol. 94, no. 6, pp. 935–943. doi:10.1111/cen.14440

[21]. Li, N., Li, X.M., Xu, L., et al., 2013, Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women, International Journal of Endocrinology, vol. 2013, Article ID 895474. doi:10.1155/2013/895474

[22]. Deshpande, N., Hadi, M. S., Lillard, J. C., et al., 2023, Alternatives to DEXA for the Assessment of Bone Density: A Systematic Review of the Literature and Future Recommendations, Journal of Neurosurgery: Spine, vol. 38, no. 4, pp. 436–445. doi:10.3171/2022.11.SPINE22875

[23]. Pu, M., Zhang, B., Zhu, Y., Zhong, W., Shen, Y., Zhang, P., 2023, Hounsfield Unit for Evaluating Bone Mineral Density and Strength: Variations in Measurement Methods, World Neurosurgery, vol. 180, pp. e56–e68. doi:10.1016/j.wneu.2023.07.146.