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Effect of degeneration on bone mineral density, trabecular bone score and CT Hounsfield unit measurements in a spine surgery patient population

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Abstract

Summary

This study investigated the impact of spinal degeneration on bone mineral density (BMD), trabecular bone score (TBS), and CT Hounsfield units in an at-risk population. We found that BMD was increased by degeneration, whereas TBS and HU were unaffected. These findings support that TBS is not adversely affected by spinal degeneration.

Introduction

This study evaluated the impact of spinal degeneration on BMD and TBS measured by dual-energy x-ray absorptiometry (DXA) and on CT HU in a spine surgery patient population.

Methods

A retrospective study of 63 patients referred for consideration of spine surgery or with history of spine surgery was performed. Patients were included if a DXA scan and a CT containing the lumbar spine were obtained within 18 months of each other. DXA data were collected and analyzed by vertebral level. Individual vertebrae were assessed for degenerative changes by qualitative evaluation of the anterior and posterior elements using CT. Degeneration scores were compared to BMD T-scores, TBS and CT HU at individual vertebral levels L1-4, and after applying International Society for Clinical Densitometry (ISCD) criteria for excluding vertebrae from diagnostic consideration.

Results

Mean patient age and BMI were 67.2 years and 27.8 kg/m2, respectively; 79.4% were female. Mean (SD) lowest T-scores of the hip, spine, and lowest overall T-score were − 1.3 (1.4), − 1.7 (0.9), and − 1.9 (1.0), respectively. Osteoporosis was present by T-score in 38% and osteopenia in 52%; 10% had a history of osteoporotic fracture. The mean degeneration score of individual vertebrae was 4.1 on a 0–6 scale. T-score correlated moderately with degeneration score (Spearman’s rho 0.484, p < 0.001), whereas TBS and HU were unrelated. ISCD excluded vertebrae had a higher degeneration score than included vertebrae (p =  < 0.001).

Conclusions

In a spine surgery population, TBS and CT HU values are unrelated to degeneration score and thus appear unaffected by lumbar vertebral degenerative changes. Additionally, these data support the ISCD criteria for vertebral exclusion.

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Data availability

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Abbreviations

DXA:

Dual energy x-ray absorptiometry

TBS:

Trabecular bone score

HU:

CT Hounsfield Unit

BMD:

Bone mineral density

ROI:

Region of interest

WHO:

World Health Organization

NOF:

National Osteoporosis Foundation

ISCD:

International Society for Clinical Densitometry

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Funding

University of Wisconsin School of Medicine and Public Health Shapiro Research Fellowship Program.

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Authors and Affiliations

  1. University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, USA

    A. C. Hayden, N. Binkley, D. Krueger, J. T. Bernatz & A. Kadri

  2. Department of Orthopedics Surgery and Rehabilitation, University of Wisconsin, UWMF Centennial Bldg, 1685 Highland Ave, 6th floor, Madison, WI, 53705-2281, USA

    P. A. Anderson

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  1. A. C. Hayden
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  2. N. Binkley
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Correspondence to P. A. Anderson.

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Determined exempt by the UW Health Sciences IRB: Submission ID Number 2020–0624. For this type of study formal consent is not required.

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Conflicts of interest

The authors Alexander C. Hayden, BS, Neil Binkley, MD1, Diane Krueger, BS, James T. Bernatz, MD, Aamir Kadri, MS, and Paul A. Anderson, MD, declare that they have no conflict of interest.

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Hayden, A.C., Binkley, N., Krueger, D. et al. Effect of degeneration on bone mineral density, trabecular bone score and CT Hounsfield unit measurements in a spine surgery patient population. Osteoporos Int 33, 1775–1782 (2022). https://doi.org/10.1007/s00198-022-06407-w

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