CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case-control analysis
- 296 Downloads
This matched case-control study compared the computed tomography (CT)-based regional bone density of patients with fragility fractures of the sacrum to a control without fracture. Patients with a sacral fracture demonstrated a significantly lower regional bone density of the sacrum, the sacral bone density not being correlated with the BMD by DXA of the spine.
The aim of this study is to compare the computed tomography-based regional bone density measured by Hounsfield units (HUs) in patients with and without fragility fractures of the sacrum.
Patients aged ≥ 50 years with a fragility fracture of the sacrum were compared to patients of similar age and gender who had a fall from standing height without fracture (n = 46). A matched case-control analysis was conducted by retrospective chart review and assessment of areal bone mineral density by lumbar DXA and by volumetric regional HU measurements in uncalibrated CT scans of the sacrum.
Patients with a sacral fracture (age 74 ± 11 years) showed a lower bone density in the body of S1 (HU 85 ± 22) when compared to the matched control group without fracture (age 73 ± 10 years, HU 125 ± 37, p < 0.001). The CT-based bone density of S1 did not correlate with the DXA values of the lumbar spine (r = 0.223, p = 0.136), and lumbar spine T-scores did not differ between the groups (− 2.0 ± 1.3 vs. − 1.9 ± 1.2, p = 0.786). All measurements are based on uncalibrated scans, and absolute HU values are restricted to scans made on Siemens SOMATOM Force or SOMATOM Edge scanners.
Patients with fragility fractures of the sacrum demonstrated a lower regional volumetric bone density of the sacrum when compared to a cohort without a fracture. Local sacral volumetric bone density as measured by CT seems to be independent from the areal BMD as measured by DXA of the lumbar spine.
Level of evidence: level III.
KeywordsComputed tomography Dual-energy X-ray absorptiometry Hounsfield units Osteoporosis Pelvic fracture Sacral fracture
Compliance with ethical standards
The protocol of the present study was approved by the local ethics committee (Kantonale Ethik-Kommission Zürich, KEK-ZH-Nr. 2016–01758).
Conflicts of interest
- 1.Wagner D, Kamer L, Sawaguchi T, Richards RG, Noser H, Rommens PM (2016) Sacral bone mass distribution assessed by averaged three-dimensional CT models: implications for pathogenesis and treatment of fragility fractures of the sacrum. J Bone Joint Surg Am 98(7):584–590. https://doi.org/10.2106/JBJS.15.00726 CrossRefPubMedGoogle Scholar
- 2.Gauthier A, Kanis JA, Jiang Y, Martin M, Compston JE, Borgstrom F, Cooper C, McCloskey EV (2011) Epidemiological burden of postmenopausal osteoporosis in the UK from 2010 to 2021: estimations from a disease model. Arch Osteoporos 6(1-2):179–188. https://doi.org/10.1007/s11657-011-0063-y CrossRefPubMedGoogle Scholar
- 9.Baum T, Carballido-Gamio J, Huber MB, Müller D, Monetti R, Räth C, Eckstein F, Lochmüller EM, Majumdar S, Rummeny EJ, Link TM, Bauer JS (2010) Automated 3D trabecular bone structure analysis of the proximal femur—prediction of biomechanical strength by CT and DXA. Osteoporos Int 21(9):1553–1564. https://doi.org/10.1007/s00198-009-1090-z CrossRefPubMedGoogle Scholar
- 10.Marinova M, Edon B, Wolter K, Katsimbari B, Schild HH, Strunk HM (2015) Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis. Curr Med Res Opin 31(10):1871–1881. https://doi.org/10.1185/03007995.2015.1074892 CrossRefPubMedGoogle Scholar
- 14.Rosner B (1995) Fundamentals of biostatistics, 4th edn. Duxbury PressGoogle Scholar
- 15.Breslow NE, Day NE (1980) Statistical methods in cancer research. Volume I—the analysis of case-control studies. IARC Sci Publ (32):5–338Google Scholar
- 16.Wagner D, Kamer L, Rommens PM, Sawaguchi T, Richards RG, Noser H (2014) 3D statistical modeling techniques to investigate the anatomy of the sacrum, its bone mass distribution, and the trans-sacral corridors. J Orthop Res 32(11):1543–1548. https://doi.org/10.1002/jor.22667 CrossRefPubMedGoogle Scholar
- 18.Linstrom NJ, Heiserman JE, Kortman KE, Crawford NR, Baek S, Anderson RL, Pitt AM, Karis JP, Ross JS, Lekovic GP, Dean BL (2009) Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine (Phila Pa 1976) 34(4):309–315. https://doi.org/10.1097/BRS.0b013e318191ea01 CrossRefGoogle Scholar
- 20.Burke CJ, Didolkar MM, Barnhart HX, Vinson EN (2016) The use of routine non density calibrated clinical computed tomography data as a potentially useful screening tool for identifying patients with osteoporosis. Clin Cases Miner Bone Metab 13(2):135–140. 10.11138/ccmbm/2016.13.2.135 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ (2016) Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int 27(3):1131–1136. https://doi.org/10.1007/s00198-015-3318-4 CrossRefPubMedGoogle Scholar
- 25.Turkyilmaz I, Aksoy U, McGlumphy EA (2008) Two alternative surgical techniques for enhancing primary implant stability in the posterior maxilla: a clinical study including bone density, insertion torque, and resonance frequency analysis data. Clin Implant Dent Relat Res 10(4):231–237. https://doi.org/10.1111/j.1708-8208.2008.00084.x CrossRefPubMedGoogle Scholar
- 27.Turkyilmaz I, Tumer C, Ozbek EN, Tozum TF (2007) Relations between the bone density values from computerized tomography, and implant stability parameters: a clinical study of 230 regular platform implants. J Clin Periodontol 34(8):716–722. https://doi.org/10.1111/j.1600-051X.2007.01112.x CrossRefPubMedGoogle Scholar
- 28.Lund T, Oxland TR, Jost B, Cripton P, Grassmann S, Etter C, Nolte LP (1998) Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg Br 80(2):351–359. https://doi.org/10.1302/0301-620X.80B2.7693 CrossRefPubMedGoogle Scholar
- 29.Osterhoff G, Dodd AE, Unno F, Wong A, Amiri S, Lefaivre KA, Guy P (2016) Cement augmentation in sacroiliac screw fixation offers modest biomechanical advantages in a cadaver model. Clin Orthop Relat Res 474(11):2522–2530. https://doi.org/10.1007/s11999-016-4934-9 CrossRefPubMedPubMedCentralGoogle Scholar