Abstract
Introduction
The osteoporosis self-assessment tool for Asians (OSTA) is a common screening tool for osteoporosis. The seventh thoracic CT (CT-T7) Hounsfield unit (HU) measured by chest CT correlates with osteoporosis. This study aimed to investigate the diagnostic value of OSTA alone, CT-T7 alone, or the combination of OSTA and CT-T7 in osteoporosis.
Materials and methods
In this study, 1268 participants were grouped into 586 men and 682 women. We established multiple linear regression models by combining CT-T7 and OSTA. Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose osteoporosis.
Results
In the male group, the mean age was 59.02 years, and 108 patients (18.4%) had osteoporosis. In the female group, the mean age was 63.23 years, and 308 patients (45.2%) had osteoporosis. By ROC curve comparison, the CT-T7 (male, AUC = 0.789, 95% CI 0.745–0.832; female, AUC = 0.835, 95% CI 0.805–0.864) in the diagnosis of osteoporosis was greater than the OSTA (male, AUC = 0.673, 95% CI 0.620–0.726; female, AUC = 0.775, 95% CI 0.741–0.810) in both the male and female groups (p < 0.001). When OSTA was combined with CT, the equation of multiple linear regression (MLR) was obtained as follows: female = 3.020–0.028*OSTA-0.004*CT-T7. In the female group, it was found that the AUC of MLR (AUC = 0.853, 95% CI 0.825–0.880) in the diagnosis of osteoporosis was larger than that of CT-T7 (p < 0.01). When the MLR was 2.65, the sensitivity and specificity were 53.9% and 90%, respectively.
Conclusion
For a patient who has completed chest CT, CT-T7 (HU) combined with OSTA is recommended to identify the high-risk population of osteoporosis, and it has a higher diagnostic value than OSTA alone or CT-T7 alone, especially among females. For a female with MLR greater than 2.65, further DXA examination is needed.
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Data Availability
The data and analytic code for this study may be available from the corresponding author on reasonable request.
References
Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–6.
Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, et al. A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int. 2012;23(5):1623–9.
Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12(8):699–705.
Bhat KA, Kakaji M, Awasthi A, Kumar K, Mishra K, Shukla M, et al. Utility of osteoporosis self-assessment tool as a screening tool for predicting osteoporosis in Indian men. J Clin Densitom. 2017;20(2):160–3.
Chen JH, Chen YC, Tsai MK, Chiou JM, Lee WC, Tsao CK, et al. Predicting the risk of osteopenia for women aged 40–55 years. J Formos Med Assoc. 2017;116(11):888–96.
Huang JY, Song WZ, Huang M. Effectiveness of osteoporosis self-assessment tool for Asians in screening for osteoporosis in healthy males over 40 years old in China. J Clin Densitom. 2017;20(2):153–9.
Huang JY, Song WZ, Zeng HR, Huang M, Wen QF. Performance of the osteoporosis self-assessment tool for Asians (OSTA) in screening osteoporosis among middle-aged and old women in the Chengdu region of China. J Clin Densitom. 2015;18(4):539–45.
Oh SM, Nam BH, Rhee Y, Moon SH, Kim DY, Kang DR, et al. Development and validation of osteoporosis risk-assessment model for Korean postmenopausal women. J Bone Miner Metab. 2013;31(4):423–32.
Satyaraddi A, Shetty S, Kapoor N, Cherian KE, Naik D, Thomas N, et al. Performance of risk assessment tools for predicting osteoporosis in south Indian rural elderly men. Arch Osteoporos. 2017;12(1):35.
Subramaniam S, Chan CY, Soelaiman IN, Mohamed N, Muhammad N, Ahmad F, et al. The performance of osteoporosis self-assessment tool for Asians (OSTA) in identifying the risk of osteoporosis among Malaysian population aged 40 years and above. Arch Osteoporos. 2019;14(1):117.
Mettler FA Jr, Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, et al. Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys. 2008;95(5):502–7.
Mv Dort, Driessen JHM, Geusens P, Romme E, Smeenk F, Wouters EFM, et al. Vertebral bone attenuation in Hounsfield units and prevalent vertebral fractures are associated with the short-term risk of vertebral fractures in current and ex-smokers with and without COPD: a 3-year chest CT follow-up study. Osteoporos Int. 2019;30(8):1561–71.
Pan Y, Shi D, Wang H, Chen T, Cui D, Cheng X, et al. Automatic opportunistic osteoporosis screening using low-dose chest computed tomography scans obtained for lung cancer screening. Eur Radiol. 2020;30(7):4107–16.
Romme EA, Murchison JT, Phang KF, Jansen FH, Rutten EP, Wouters EF, et al. Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res. 2012;27(11):2338–43.
Wang P, She W, Mao Z, Zhou X, Li Y, Niu J, et al. Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies. Skeletal Radiol. 2021;50(2):371–9.
Therkildsen J, Nissen L, Jorgensen HS, Thygesen J, Ivarsen P, Frost L, et al. Thoracic bone mineral density derived from cardiac CT is associated with greater fracture rate. Radiol. 2020;296(3):499–508.
Boutin RD, Hernandez AM, Lenchik L, Seibert JA, Gress DA, Boone JM. CT phantom evaluation of 67,392 American College of Radiology Accreditation Examinations: implications for opportunistic screening of osteoporosis using CT. AJR Am J Roentgenol. 2021;216(2):447–52.
Amin MFM, Zakaria WMW, Yahya N. Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA. Skeletal Radiol. 2021;50(12):2525–35.
Driessen JHM, van Dort MJ, Romme E, Wouters EFM, Smeenk F, van Rietbergen B, et al. Associations between bone attenuation and prevalent vertebral fractures on chest CT scans differ with vertebral fracture locations. Osteoporos Int. 2021;32(9):1869–77.
Jang S, Graffy PM, Ziemlewicz TJ, Lee SJ, Summers RM, Pickhardt PJ. Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20 000 adults. Radiol. 2019;291(2):360–7.
Crandall CJ, Larson J, Gourlay ML, Donaldson MG, LaCroix A, Cauley JA, et al. Osteoporosis screening in postmenopausal women 50 to 64 years old: comparison of US preventive services task force strategy and two traditional strategies in the Women’s Health Initiative. J Bone Miner Res. 2014;29(7):1661–6.
Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA, et al. Selection of women aged 50–64 yr for bone density measurement. J Clin Densitom. 2013;16(4):570–8.
Diem SJ, Peters KW, Gourlay ML, Schousboe JT, Taylor BC, Orwoll ES, et al. Screening for osteoporosis in older men: operating characteristics of proposed strategies for selecting men for BMD testing. J Gen Intern Med. 2017;32(11):1235–41.
Garner HW, Paturzo MM, Gaudier G, Pickhardt PJ, Wessell DE. Variation in attenuation in L1 trabecular bone at different tube voltages: caution is warranted when screening for osteoporosis with the use of opportunistic CT. AJR Am J Roentgenol. 2017;208(1):165–70.
Yang J, Liao M, Wang Y, Chen L, He L, Ji Y, et al. Opportunistic osteoporosis screening using chest CT with artificial intelligence. Osteoporos Int. 2022;208:165.
Na MK, Won YD, Kim CH, Kim JM, Cheong JH, Ryu JI, et al. Opportunistic osteoporosis screening via the measurement of frontal skull Hounsfield units derived from brain computed tomography images. PLoS ONE. 2018;13(5):e0197336.
Johnson CC, Gausden EB, Weiland AJ, Lane JM, Schreiber JJ. Using Hounsfield units to assess osteoporotic status on wrist computed tomography scans: comparison with dual energy X-ray absorptiometry. J Hand Surg Am. 2016;41(7):767–74.
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(8):588–95.
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Zhang, J., Zhou, R., Luo, X. et al. Routine chest CT combined with the osteoporosis self-assessment tool for Asians (OSTA): a screening tool for patients with osteoporosis. Skeletal Radiol 52, 1169–1178 (2023). https://doi.org/10.1007/s00256-022-04255-7
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DOI: https://doi.org/10.1007/s00256-022-04255-7