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Quantitative computed tomography discriminates between postmenopausal women with low spine bone mineral density with vertebral fractures and those with low spine bone mineral density only: the SHATTER study

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Abstract

Summary

Lumbar spine volumetric bone mineral density (BMD) measured using quantitative computed tomography (QCT) can discriminate between postmenopausal women with low areal BMD with and without vertebral fractures. QCT provides a 3D measure of BMD, excludes the vertebral posterior elements and accounts for bone size. This knowledge could contribute to effective treatment targeting of patients with low BMD.

Introduction

We evaluated the ability of lumbar spine bone mineral apparent density (BMAD), trabecular bone score (TBS) and volumetric bone mineral density (vBMD) to discriminate between postmenopausal women with low areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) with and without vertebral fractures. The discriminatory ability of lumbar spine aBMD was compared with that of BMAD, TBS and vBMD.

Methods

We studied three groups of postmenopausal women, i.e. group 1, aBMD T-score < − 1.0 and ≥ 1 vertebral fracture (n = 39); group 2, aBMD T-score < − 1.0 and no vertebral fracture, age- and aBMD-matched to group 1 (n = 34); group 3, aBMD score > − 1 and no vertebral fracture, age-matched to group 1 (n = 37). Lumbar spine aBMD was measured by DXA. BMAD was calculated using the DXA scan results. TBS was derived following DXA scan image reanalysis. Lumbar spine vBMD was assessed by quantitative computed tomography and Mindways Pro software. Differences in variables between groups 1, 2 and 3 were examined using general linear univariate modelling approaches. Area under the receiver operating characteristic (ROC) curve was calculated for BMAD, TBS and vBMD to determine the ability of lumbar spine measurement variables to discriminate between group 1 and group 2. A comparison of ROCs was performed.

Results

Lumbar spine BMAD and TBS measurement variables were similar for groups 1 and 2. However, vBMD was significantly lower in group 1 and could discriminate between those women with low aBMD with (group 1) and without vertebral fractures (group 2).

Conclusions

We conclude that lumbar spine vBMD may discriminate well between postmenopausal women with low aBMD with and without vertebral fractures as it provides a 3D measure of bone mineral density, excludes the posterior elements of the vertebrae and takes into account bone size. A unique feature of the SHATTER study is that groups 1 and 2 were matched for aBMD, thus our study findings are independent of aBMD. Furthermore, we observed that neither BMAD nor TBS could distinguish between women with low aBMD with and without vertebral fractures. The knowledge gained from the SHATTER study will influence clinical and therapeutic decision-making, thereby optimising the care of patients with and without vertebral and other fragility fractures.

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Abbreviations

AUC:

area under the curve

aBMD:

areal bone mineral density

BMAD:

bone mineral apparent density

TBS:

trabecular bone score

vBMD:

volumetric bone mineral density.

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Funding

This work was funded by the National Institute for Health Research (NIHR) via its Biomedical Research Units Funding Scheme and the NIHR Sheffield Clinical Research Facility, Northern General Hospital, Sheffield, UK.

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Authors and Affiliations

  1. The Mellanby Centre for Bone Research, Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK

    M. A. Paggiosi, J. S. Walsh & R. Eastell

  2. Department of Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    M. Debono

  3. The MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, UK

    J. S. Walsh & R. Eastell

  4. The Mellanby Centre for Bone Research, Metabolic Bone Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    N. F. A. Peel

Authors
  1. M. A. Paggiosi
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  2. M. Debono
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  3. J. S. Walsh
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  4. N. F. A. Peel
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  5. R. Eastell
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Correspondence to M. A. Paggiosi.

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Paggiosi, M.A., Debono, M., Walsh, J.S. et al. Quantitative computed tomography discriminates between postmenopausal women with low spine bone mineral density with vertebral fractures and those with low spine bone mineral density only: the SHATTER study. Osteoporos Int 31, 667–675 (2020). https://doi.org/10.1007/s00198-020-05317-z

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