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Comparison of DXA-based versus CT-based indices to predict prevalent fracture history in men with spinal cord injury

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Abstract

Summary

Fracture risk prediction remains challenging in adults with spinal cord injury. Here, we compare the ability of CT- and DXA-derived indices to discriminate between those with and without prevalent osteoporotic fracture. Novel CT-derived indices may offer improved assessment of fragility fracture risk as well as improved monitoring of response to therapies.

Introduction

Individuals with spinal cord injury are particularly susceptible to osteoporosis. As advanced imaging techniques become more readily available clinically, there is limited information on the relative strength of various outcomes for fracture risk prediction. The purpose of this study was to compare the ability of DXA-based versus CT-based indices to predict prevalent fracture history in adults with spinal cord injury.

Methods

Thirty-six men with known SCI underwent dual energy X-ray absorptiometry and computed tomography assessments of the lower extremities. We used age-adjusted area under the curve models to compare the predictive value for each bone parameter to identify prevalent fracture history.

Results

CT-based indices outperformed DXA-based indices at all sites. The site with the highest AUC was the trabecular BMD at the proximal tibial epiphysis.

Conclusions

CT imaging may have clinical utility to improve fracture risk prediction in adults with SCI. More work is needed to confirm these findings and to assess the value of CT-based indices to predict incident fracture, monitor longitudinal bone loss, and monitor response to various therapies, both pharmacological and rehabilitation.

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Funding

This work was supported by the Office of the Secretary of Defense for Health Affairs through the Spinal Cord Injury Clinical Trial Program under Award Numbers W81XWH-15-2-0078 and W81XWH-10-1-1043. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

Author information

Authors and Affiliations

  1. Grandview Medical Center, Dayton, OH, USA

    Michael J. Matthews

  2. Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA

    Karen L. Troy

  3. Department of Rehabilitation Medicine, University of Minnesota School of Medicine, 500 Boynton Health Service Bridge, 410 Church St. SE, Minneapolis, MN, 55455, USA

    Ricardo A. Battaglino, Nguyen Nguyen, Richard Goldstein & Leslie R. Morse

Authors
  1. Michael J. Matthews
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  2. Karen L. Troy
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  3. Ricardo A. Battaglino
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  4. Nguyen Nguyen
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  5. Richard Goldstein
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  6. Leslie R. Morse
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Correspondence to Leslie R. Morse.

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Matthews, M.J., Troy, K.L., Battaglino, R.A. et al. Comparison of DXA-based versus CT-based indices to predict prevalent fracture history in men with spinal cord injury. Osteoporos Int 34, 319–325 (2023). https://doi.org/10.1007/s00198-022-06575-9

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  • DOI: https://doi.org/10.1007/s00198-022-06575-9

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