Skip to main content

The effect of contrast media on CT measures of bone mineral density: a systematic review



The aim was to systematically assess the literature on possible effect of administration of iodinated contrast media on CT-estimated bone mineral density (BMD).

Materials and methods

The Web of Science and PubMed databases were searched. Studies that used both CT principles of BMD measurement (volumetric quantitative BMD and CT attenuation in Hounsfield Units) were included. The baseline patient data, skeletal site, contrast medium data (if reported), and change in BMD on contrast-enhanced CT scans were collected.


Sixteen studies met our review criteria, the majority of which was performed on lumbar spine, and the others on proximal femur. Almost all studies reported a significant increase in BMD values on the contrast-enhanced CT scans, ranging from 0.8 to 30.3%. The increase was most frequently reported to be about 10 to 15% for the spine and 5 to 10% for the femur. In addition to the difference in skeletal site, some authors found the contrast effect was age-, sex-, and contrast dose-dependent. BMD values in arterial phase were generally somewhat lower than in venous phase, and the effect of contrast in venous phase was more predictable.


The review revealed significant changes in BMD values between unenhanced and contrast-enhanced CT. The change was more pronounced in lumbar spine than in proximal femur and appeared to depend on age, sex, contrast dose, and postcontrast imaging protocol. The review suggests the understanding of all mentioned factors during the interpretation of BMD measured on contrast-enhanced CT.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Delsmann MM, Strahl A, Mühlenfeld M, et al. High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty. Osteoporos Int. 2021;32:1661–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Link TM. Osteoporosis imaging: state of the art and advanced imaging. Radiology. 2012;263:3–17.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir [Wien]. 2016;158:1421–7.

    Article  PubMed  Google Scholar 

  4. Alawi M, Begum A, Harraz M, et al. Dual-energy x-ray absorptiometry (DEXA) scan versus computed tomography for bone density assessment. Cureus. 2021;13:e13261.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Adams JE. Quantitative computed tomography. Eur J Radiol. 2009;71:415–24.

    Article  PubMed  Google Scholar 

  6. Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158:588–95.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schöckel L, Jost G, Seidensticker P, Lengsfeld P, Palkowitsch P, Pietsch H. Developments in x-ray contrast media and the potential impact on computed tomography. Invest Radiol. 2020;55:592–7.

    Article  PubMed  Google Scholar 

  8. Hopper KD, Wang MP, Kunselman AR. The use of clinical CT for baseline bone density assessment. J Comput Assist Tomogr. 2000;24:896–9.

    Article  CAS  PubMed  Google Scholar 

  9. Bauer JS, Henning TD, Müeller D, Lu Y, Majumdar S, Link TM. Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors. AJR Am J Roentgenol. 2007;188:1294–301.

    Article  PubMed  Google Scholar 

  10. Acu K, Scheel M, Issever AS. Time dependency of bone density estimation from computed tomography with intravenous contrast agent administration. Osteoporos Int. 2014;25:535–42.

    Article  CAS  PubMed  Google Scholar 

  11. Pickhardt PJ, Lauder T, Pooler BD, et al. Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening. Osteoporos Int. 2016;27:147–52.

    Article  CAS  PubMed  Google Scholar 

  12. Pompe E, Willemink MJ, Dijkhuis GR, Verhaar HJ, Mohamed Hoesein FA, de Jong PA. Intravenous contrast injection significantly affects bone mineral density measured on CT. Eur Radiol. 2015;25:283–9.

    Article  PubMed  Google Scholar 

  13. Boutin RD, Kaptuch JM, Bateni CP, Chalfant JS, Yao L. Influence of IV contrast administration on CT measures of muscle and bone attenuation: implications for sarcopenia and osteoporosis evaluation. AJR Am J Roentgenol. 2016;207:1046–54.

    Article  PubMed  Google Scholar 

  14. Islamian JP, Garoosi I, Abdollahi Fard K, Abdollahi MR. How much intravenous contrast media affect bone mineral density (BMD) assessed by routine computed tomography (CT). The Egyptian J Radiol Nucl Med. 2016;47:571–5.

    Article  Google Scholar 

  15. Jørgensen HS, Winther S, Bøttcher M, et al. effect of intravenous contrast on volumetric bone mineral density in patients with chronic kidney disease. J Clin Densitom. 2016;19:423–9.

    Article  PubMed  Google Scholar 

  16. Ziemlewicz TJ, Maciejewski A, Binkley N, Brett AD, Brown JK, Pickhardt PJ. Direct comparison of unenhanced and contrast-enhanced CT for opportunistic proximal femur bone mineral density measurement: implications for osteoporosis screening. AJR Am J Roentgenol. 2016;206:694–8. (PMID: 26866336).

    Article  PubMed  Google Scholar 

  17. Abdullayev N, Neuhaus VF, Bratke G, et al. Effects of contrast enhancement on in-body calibrated phantomless bone mineral density measurements in computed tomography. J Clin Densitom. 2018;21:360–6.

    Article  PubMed  Google Scholar 

  18. Toelly A, Bardach C, Weber M, et al. Influence of contrast media on bone mineral density (BMD) measurements from routine contrast-enhanced MDCT datasets using a phantom-less bmd measurement tool. Rofo. 2017;189:537–43.

    Article  PubMed  Google Scholar 

  19. Elsayed NM, Esmail MA, Abdulsattar EK. Does intravenous contrast used in computed tomography affect the bone mineral density? Clinical Medicine and Diagnostics. 2018;8:53–8.

    Article  Google Scholar 

  20. Gerety EL, Bearcroft PW. L1 vertebral density on CT is too variable with different scanning protocols to be a useful screening tool for osteoporosis in everyday practice. Br J Radiol. 2018;91:20170395.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lee HW, Ha HI, Park SY, Lim HK. Reliability of 3D image analysis and influence of contrast medium administration on measurement of Hounsfield unit values of the proximal femur. PLoS ONE. 2020;15:e0241012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Perez AA, Pickhardt PJ, Elton DC, Sandfort V, Summers RM. Fully automated CT imaging biomarkers of bone, muscle, and fat: correcting for the effect of intravenous contrast. Abdom Radiol (NY). 2021;46:1229–35.

    Article  PubMed  Google Scholar 

  23. Woisetschläger M, Klintström E, Spångeus A. The impact of imaging time and contrast agent dose on screening for osteoporosis with contrast-enhanced CT. Eur Radiol Exp. 2022;6:8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study. J Anat. 1980;131:57–79 (PMID: 7440404).

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Griessenauer CJ, Raborn J, Foreman P, Shoja MM, Loukas M, Tubbs RS. Venous drainage of the spine and spinal cord: a comprehensive review of its history, embryology, anatomy, physiology, and pathology. Clin Anat. 2015;28:75–87.

    Article  PubMed  Google Scholar 

  26. Lahtinen T, Alhava EM, Karjalainen P, Romppanen T. The effect of age on blood flow in the proximal femur in man. J Nucl Med. 1981;22:966–72 (PMID: 7299482).

    CAS  PubMed  Google Scholar 

  27. Poole KES, Skingle L, Gee AH, et al. Focal osteoporosis defects play a key role in hip fracture. Bone. 2017;94:124–34.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Prisby RD, Ramsey MW, Behnke BJ, et al. Aging reduces skeletal blood flow, endothelium-dependent vasodilation, and NO bioavailability in rats. J Bone Miner Res. 2007;22:1280–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Danijela Budimir Mršić.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kutleša, Z., Jerković, K., Ordulj, I. et al. The effect of contrast media on CT measures of bone mineral density: a systematic review. Skeletal Radiol 52, 687–694 (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Osteoporosis
  • Computed tomography
  • Bone mineral density
  • Hounsfield unit
  • Contrast media