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Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Opportunistic screening for osteoporosis using computed tomography (CT) examinations that happen to visualise the spine can be used to identify patients with osteoporosis. We sought to verify the diagnostic performance of vertebral Hounsfield unit (HU) measurements on routine CT examinations for diagnosing osteoporosis in a separate, external population.

Methods

Consecutive patients who underwent a CT examination of the chest or abdomen and had also received a dual-energy X-ray absorptiometry (DXA) test were retrospectively included. CTs were evaluated for vertebral fractures and vertebral attenuation (density) values were measured. Diagnostic performance measures and the area under the receiver operator characteristics curve (AUC) for diagnosing osteoporosis were calculated.

Results

Three hundred and two patients with a mean age of 57.9 years were included, of which 82 (27 %) had osteoporosis according to DXA and 65 (22 %) had vertebral fractures. The diagnostic performance for vertebral HU measurements was modest, with a maximal AUC of 0.74 (0.68 – 0.80). At that optimal threshold the sensitivity was 62 % (51 – 72 %) and the specificity was 79 % (74 – 84 %).

Conclusions

We confirmed that simple trabecular vertebral density measurements on routine CT contain diagnostic information related to bone mineral density as measured by DXA, albeit with substantially lower diagnostic accuracy than previously reported.

Key Points

• We externally validated the value of vertebral trabecular bone attenuation for osteoporosis

• These diagnostic performance measures were, however, substantially lower than previously reported

• This information might be useful when considering the implementation of opportunistic osteoporosis screening

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Acknowledgments

The scientific guarantor of this publication is Pim De Jong. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the Netherlands Organization for Scientific Research-Medical Sciences (NWO-MW) grant 40-00812-98-07-005. One of the authors has significant statistical expertise. Institutional review board approval was not required due to previous blanket approval of anonymous retrospective studies on retained diagnostic information that does not impact patient care.

Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands

    Constantinus F. Buckens, Gawein Dijkhuis & Pim A. de Jong

  2. Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    Bart de Keizer

  3. Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    Harald J. Verhaar

  4. Department of Radiology, Universitair Medisch Centrum Utrecht, Huispostnummer E01.132, 3508 GA, Utrecht, The Netherlands

    Constantinus F. Buckens

Authors
  1. Constantinus F. Buckens
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  2. Gawein Dijkhuis
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  3. Bart de Keizer
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  4. Harald J. Verhaar
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  5. Pim A. de Jong
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Corresponding author

Correspondence to Constantinus F. Buckens.

Electronic supplementary material

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Figure 4

Receiver operating characteristics curve for vertebral bone density model predicting DXA-assigned osteoporosis for women (dashed grey line) and men (solid black line) separately, with the area under the cure (AUC) for each printed in the legend. (PDF 5 kb)

Table 3

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Table 4

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Buckens, C.F., Dijkhuis, G., de Keizer, B. et al. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol 25, 2074–2079 (2015). https://doi.org/10.1007/s00330-014-3584-0

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  • DOI: https://doi.org/10.1007/s00330-014-3584-0

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