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Quantitative computed tomography has higher sensitivity detecting critical bone mineral density compared to dual-energy X-ray absorptiometry in postmenopausal women and elderly men with osteoporotic fractures: a real-life study

  • Orthopaedic Surgery
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Abstract

Introduction

Dual-energy X-ray absorptiometry (DXA) is considered the gold standard for the diagnosis of osteoporosis and assessment of fracture risk despite proven limitations. Quantitative computed tomography (QCT) is regarded as a sensitive method for diagnosis and follow-up. Pathologic fractures are classified as the main clinical manifestation of osteoporosis. The objective of the study was to compare DXA and QCT to determine their sensitivity and discriminatory power.

Materials and methods

Patients aged 50 years and older were included who had DXA of the lumbar spine and femur and additional QCT of the lumbar spine within 365 days. Fractures and bone mineral density (BMD) were retrospectively examined. BMD measurements were analyzed for the detection of osteoporotic fractures. Sensitivity and receiver operating characteristic curve were used for calculations. As an indication for a second radiological examination was given, the results were compared with control groups receiving exclusively DXA or QCT for diagnosis or follow-up.

Results

Overall, BMD measurements of 404 subjects were analyzed. DXA detected 15 (13.2%) patients having pathologic fractures (n = 114) with normal bone density, 66 (57.9%) with osteopenia, and 33 (28.9%) with osteoporosis. QCT categorized no patients having pathologic fractures with healthy bone density, 14 (12.3%) with osteopenia, and 100 (87.7%) with osteoporosis. T-score DXA, trabecular BMD QCT, and cortical BMD QCT correlated weakly. Trabecular BMD QCT and cortical BMD QCT classified osteoporosis with decreased bone mineral density (AUC 0.680; 95% CI 0.618–0.743 and AUC 0.617; 95% CI 0.553–0.682, respectively). T-score DXA could not predict prevalent pathologic fractures. In control groups, each consisting of 50 patients, DXA and QCT were significant classifiers to predict prevalent pathologic fractures.

Conclusion

Our results support that volumetric measurements by QCT in preselected subjects represent a more sensitive method for the diagnosis of osteoporosis and prediction of fractures compared to DXA.

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Abbreviations

AUC:

Area under the curve

cBMD:

Cortical bone mineral density

CI:

95% confidence interval

DXA:

Dual-energy X-ray absorptiometry

L:

Lumbar vertebrae

QCT:

Quantitative computed tomography

ROC:

Receiver operating characteristics

SD:

Standard deviation

T:

Thoracic vertebrae

tBMD:

Trabecular bone mineral density

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Acknowledgements

We thank Prof. Dr. med. Andrea Baur-Melnyk and PD Dr. Dipl.-Ing. (FH) Matthias Woiczinski for assistance and support.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Elena Boehm, Eduard Kraft, Johanna Theresia Biebl, Bernd Wegener & Isa Feist-Pagenstert

  2. Department of Rehabilitation, City Hospital Bogenhausen, Englschalkinger Straße 77, 81925, Munich, Germany

    Eduard Kraft

  3. Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany

    Robert Stahl

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EB, IF-P and RS. The first draft of the manuscript was written by EB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Johanna Theresia Biebl.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the responsible local Ethics Committee of Ludwig Maximilian University of Munich (no. 20-1126).

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The study was retrospectively registered in the Federal Institute for Drugs and Medical Devices on 06.10.2022 under the ID DRKS00024124.

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Boehm, E., Kraft, E., Biebl, J.T. et al. Quantitative computed tomography has higher sensitivity detecting critical bone mineral density compared to dual-energy X-ray absorptiometry in postmenopausal women and elderly men with osteoporotic fractures: a real-life study. Arch Orthop Trauma Surg 144, 179–188 (2024). https://doi.org/10.1007/s00402-023-05070-y

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