Osteoporosis International

, Volume 28, Issue 3, pp 983–990 | Cite as

Opportunistic screening for osteoporosis by routine CT in Southern Europe

Original Article



Feasibility evaluation of early detection of osteoporosis in oncologic patients by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed for other clinical indications, by using dual-energy X-ray absorptiometry (DXA) as reference. Abdominal CT images can identify patients with osteoporosis BMD without additional radiation exposure or cost.


The purpose of the study is to evaluate the feasibility of early detection of osteoporosis by bone mineral density (BMD) on abdominal computed tomography (CT) scans performed in oncologic patients, comparing calibrated and uncalibrated measurements by using dual-energy X-ray absorptiometry (DXA) as reference. We also performed an external validation of a threshold of 160 Hounsfield units (HU), proposed as highly sensitive.


Cohort comprised CT-DXA pairs within a 6-month period performed for any indication on 326 consecutive adults, aged 62.4 ± 12.38 years (mean ± standard deviation). CT attenuation of trabecular bone in HU was measured at the axial cross sections of L1, L2, L3, and L4 vertebrae. Vertebral compression fractures were assessed by sagittal reconstruction view. Diagnostic performance measures and the area under the receiver operator characteristic curve (AUC) for diagnosing osteoporosis were calculated.


BMD values were statistical significantly lower at any vertebral level from L1 to L4 for patients with osteoporosis defined by DXA (p < 0.001). Calibrated and uncalibrated BMD values were significantly correlated (R2 = 0.833, p < 0.01). An uncalibrated L1 CT attenuation threshold of 160 HU was more than 90 % sensitive, and a threshold of 73 HU was more than 90 % specific for distinguishing osteoporosis BMD. Fifty-nine percent of patients with vertebral compression fracture had non-osteoporotic DXA T-scores.


Abdominal CT images obtained for other reasons can identify patients with osteoporosis BMD without additional radiation exposure or cost. Uncalibrated values at L1 can detect more osteoporosis patients with spinal compression fractures than DXA in oncologic patients.


Bone density Computed tomography External validation Lumbar vertebrae Osteoporosis Screening Spinal fractures 



This work was supported by the Spanish Ministerio de Economía y Competitividad (MINECO) and by FEDER funds under Grant TEC2012-33778 and BFU2015-64380-C2-2-R (D. Moratal). This work is part of the PhD student research work of E. Alacreu, which is financed by MINECO FPI. We acknowledge Dr. Francisco K Kovacs, for his insightful comments and reviews.

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2016_3804_MOESM1_ESM.docx (982 kb)
ESM 1(DOCX 981 kb)
198_2016_3804_MOESM2_ESM.docx (24 kb)
ESM 2(DOCX 24 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  1. 1.Center for Biomaterials and Tissue EngineeringUniversitat Politècnica de ValènciaValenciaSpain
  2. 2.Department of RadiologyFundación Instituto Valenciano de OncologíaValenciaSpain

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