Osteoporosis International

, Volume 30, Issue 6, pp 1215–1222 | Cite as

Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients

  • J. Perrier-CornetEmail author
  • A. Y. Omorou
  • M. Fauny
  • D. Loeuille
  • I. Chary-Valckenaere
Original Article



Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients.


Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results.


This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA.


CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk.


Bone mineral density CT-attenuation DXA Osteoporosis Rheumatoid arthritis 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Guillemin F, Saraux A, Guggenbuhl P, Roux CH, Fardellone P, le Bihan E, Cantagrel A, Chary-Valckenaere I, Euller-Ziegler L, Flipo RM, Juvin R, Behier JM, Fautrel B, Masson C, Coste J (2005) Prevalence of rheumatoid arthritis in France: 2001. Ann Rheum Dis 64:1427–1430. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gough A, Sambrook P, Devlin J, Huissoon A, Njeh C, Robbins S, Nguyen T, Emery P (1998) Osteoclastic activation is the principal mechanism leading to secondary osteoporosis in rheumatoid arthritis. J Rheumatol 25:1282–1289PubMedGoogle Scholar
  3. 3.
    Jalava T, Sarna S, Pylkkänen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res Off J Am Soc Bone Miner Res 18:1254–1260. CrossRefGoogle Scholar
  4. 4.
    Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C (2012) Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 23:581–587. CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng CK, McDonald-Blumer H, Boire G et al (2010) Care gap in patients with early inflammatory arthritis with a high fracture risk identified using FRAX(®). J Rheumatol 37:2221–2225. CrossRefPubMedGoogle Scholar
  6. 6.
    Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S (2008) International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone 43:1115–1121. CrossRefPubMedGoogle Scholar
  7. 7.
    El Maghraoui A, Rezqi A, Mounach A et al (2010) Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatol Oxf Engl 49:1303–1310. CrossRefGoogle Scholar
  8. 8.
    Mohammad A, Lohan D, Bergin D, Mooney S, Newell J, O'Donnell M, Coughlan RJ, Carey JJ (2014) The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis. Rheumatol Oxf Engl 53:821–827. CrossRefGoogle Scholar
  9. 9.
    Adams JE (2009) Quantitative computed tomography. Eur J Radiol 71:415–424. CrossRefPubMedGoogle Scholar
  10. 10.
    Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM (2017) Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 99:1580–1590. CrossRefPubMedGoogle Scholar
  11. 11.
    Brett AD, Brown JK (2015) Quantitative computed tomography and opportunistic bone density screening by dual use of computed tomography scans. J Orthop Transl 3:178–184. CrossRefGoogle Scholar
  12. 12.
    Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, Shepherd JA, Shousboe JT (2015) Clinical use of quantitative computed tomography-based advanced techniques in the management of osteoporosis in adults: the 2015 ISCD official positions-part III. J Clin Densitom 18:393–407. CrossRefPubMedGoogle Scholar
  13. 13.
    Emohare O, Cagan A, Morgan R, Davis R, Asis M, Switzer J, Polly DW Jr (2014) The use of computed tomography attenuation to evaluate osteoporosis following acute fractures of the thoracic and lumbar vertebra. Geriatr Orthop Surg Rehabil 5:50–55. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, el-zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J (2014) Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 73:62–68. CrossRefPubMedGoogle Scholar
  15. 15.
    Alacreu E, Moratal D, Arana E (2017) Opportunistic screening for osteoporosis by routine CT in Southern Europe. Osteoporos Int 28:983–990. CrossRefPubMedGoogle Scholar
  16. 16.
    Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Buckens CF, Dijkhuis G, de Keizer B, Verhaar HJ, de Jong PA (2015) Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol 25:2074–2079. CrossRefPubMedGoogle Scholar
  18. 18.
    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 27:1131–1136. CrossRefPubMedGoogle Scholar
  19. 19.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581. CrossRefPubMedGoogle Scholar
  20. 20.
    Pickhardt PJ, Lee LJ, del Rio AM et al (2011) Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J Bone Miner Res Off J Am Soc Bone Miner Res 26:2194–2203. CrossRefGoogle Scholar
  21. 21.
    Fauny M, Bauer E, Albuisson E, Perrier-Cornet J, Deibener J, Chabot F, Mandry D, Huttin O, Chary-Valckenaere I, Loeuille D (2018) Vertebral fracture prevalence and measurement of the scanographic bone attenuation coefficient on CT-scan in patients with systemic sclerosis. Rheumatol Int 38:1901–1910. CrossRefPubMedGoogle Scholar
  22. 22.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res Off J Am Soc Bone Miner Res 8:1137–1148. CrossRefGoogle Scholar
  23. 23.
    Gerety E-L, Hopper MA, Bearcroft PWP (2017) The reliability of measuring the density of the L1 vertebral body on CT imaging as a predictor of bone mineral density. Clin Radiol 72:177.e9–177.e15. CrossRefGoogle Scholar
  24. 24.
    Budoff MJ, Malpeso JM, Zeb I, Gao YL, Li D, Choi TY, Dailing CA, Mao SS (2013) Measurement of phantomless thoracic bone mineral density on coronary artery calcium CT scans acquired with various CT scanner models. Radiology 267:830–836. CrossRefPubMedGoogle Scholar
  25. 25.
    Yu W, Glüer CC, Fuerst T et al (1995) Influence of degenerative joint disease on spinal bone mineral measurements in postmenopausal women. Calcif Tissue Int 57:169–174CrossRefPubMedGoogle Scholar
  26. 26.
    Guglielmi G, Floriani I, Torri V et al (2005) Effect of spinal degenerative changes on volumetric bone mineral density of the central skeleton as measured by quantitative computed tomography. Acta Radiol Stockh Swed 1987 46:269–275Google Scholar
  27. 27.
    Hooyman JR, Melton LJ, Nelson AM et al (1984) Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 27:1353–1361CrossRefPubMedGoogle Scholar
  28. 28.
    Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, Solomon DH (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Briot K, Roux C (2015) Glucocorticoid-induced osteoporosis. RMD Open 1:e000014. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Cortet B, Flipo RM, Blanckaert F, Duquesnoy B, Marchandise X, Delcambre B (1997) Evaluation of bone mineral density in patients with rheumatoid arthritis. Influence of disease activity and glucocorticoid therapy. Rev Rhum Engl Ed 64:451–458PubMedGoogle Scholar
  31. 31.
    Pickhardt PJ, Lauder T, Pooler BD, Muñoz del Rio A, Rosas H, Bruce RJ, Binkley N (2016) Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening. Osteoporos Int 27:147–152. CrossRefPubMedGoogle Scholar
  32. 32.
    Bartalena T, Rinaldi MF, Modolon C, Braccaioli L, Sverzellati N, Rossi G, Rimondi E, Busacca M, Albisinni U, Resnick D (2010) Incidental vertebral compression fractures in imaging studies: lessons not learned by radiologists. World J Radiol 2:399–404. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521. CrossRefPubMedGoogle Scholar
  34. 34.
    Kanis JA, Johansson H, Oden A et al (2014) Worldwide uptake of FRAX. Arch Osteoporos 9:166. CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Rheumatology departmentUniversity Hospital of NancyVandœuvre-Lès-NancyFrance
  2. 2.Inserm, CIC-1433 Clinical EpidemiologyUniversity Hospital of NancyNancyFrance

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