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Discrimination of osteoporosis-related vertebral fractures by DXA-derived 3D measurements: a retrospective case-control study

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Abstract

Summary

A retrospective case-control study assessing the association of DXA-derived 3D measurements with osteoporosis-related vertebral fractures was performed. Trabecular volumetric bone mineral density was the measurement that best discriminates between fracture and control groups.

Introduction

The aim of the present study was to evaluate the association of DXA-derived 3D measurements at the lumbar spine with osteoporosis-related vertebral fractures.

Methods

We retrospectively analyzed a database of 74 postmenopausal women: 37 subjects with incident vertebral fractures and 37 age-matched controls without any type of fracture. DXA scans at the lumbar spine were acquired at baseline (i.e., before the fracture event for subjects in the fracture group), and areal bone mineral density (aBMD) was measured. DXA-derived 3D measurements, such as volumetric BMD (vBMD), were assessed using a DXA-based 3D modeling software (3D-SHAPER). vBMD was computed at the trabecular, cortical, and integral bone. Cortical thickness and cortical surface BMD were also measured. Differences in DXA-derived measurements between fracture and control groups were evaluated using unpaired t test. Odds ratio (OR) and area under the receiver operating curve (AUC) were also computed. Subgroup analyses according to fractured vertebra were performed.

Results

aBMD of fracture group was 9.3% lower compared with control group (p < 0.01); a higher difference was found for trabecular vBMD in the vertebral body (− 16.1%, p < 0.001). Trabecular vBMD was the measurement that best discriminates between fracture and control groups, with an AUC of 0.733, against 0.682 for aBMD. Overall, similar findings were observed within the subgroup analyses. The L1 vertebral fractures subgroup had the highest AUC at trabecular vBMD (0.827), against aBMD (0.758).

Conclusion

This study showed the ability of cortical and trabecular measurements from DXA-derived 3D models to discriminate between fracture and control groups. Large cohorts need to be analyzed to determine if these measurements could improve fracture risk prediction in clinical practice.

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Funding

We would like to acknowledge the support from the Industrial Doctorates program of the Generalitat de Catalunya, as well as the QUAES Foundation - UPF Chair for Computational Tools for Healthcare. The research leading to these results has also received funding from Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad, Ministerio de Economía y Competitividad (Reference: RTC-2014-2740-1) and Eurostars program (Project ID: 9 140) funded by Centro para el Desarrollo Tecnológico Industrial, Ministerio de Economía Competitividad.

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Authors and Affiliations

  1. Musculoskeletal Unit, Galgo Medical, Barcelona, Spain

    M. López Picazo & L. Humbert

  2. BCN Medtech, Universitat Pompeu Fabra, Barcelona, Spain

    M. López Picazo & M. A. González Ballester

  3. CETIR Grup Mèdic, Barcelona, Spain

    S. Di Gregorio & L.M. del Río Barquero

  4. ICREA, Barcelona, Spain

    M. A. González Ballester

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  1. M. López Picazo
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Correspondence to M. López Picazo.

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Conflicts of interest

M. López Picazo is an employee of Galgo Medical. L. Humbert is a stockholder and employee of Galgo Medical. S. Di Gregorio, M. A. González Ballester and L. Del Rio have no conflict of interest.

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López Picazo, M., Humbert, L., Di Gregorio, S. et al. Discrimination of osteoporosis-related vertebral fractures by DXA-derived 3D measurements: a retrospective case-control study. Osteoporos Int 30, 1099–1110 (2019). https://doi.org/10.1007/s00198-019-04894-y

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