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Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density

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Abstract

Summary

Opportunistic osteoporosis screening using abdominal CT scans obtained for other purposes has the potential to increase detection of those at increased risk for fragility fractures. We sought to combine the tasks of density measurement and vertebral fracture assessment on the sagittal view. We confirm that this represents a robust approach and recommend its implementation in clinical practice.

Introduction

Opportunistic osteoporosis screening at routine abdominal CT has been proposed by measuring axial (transverse) L1 trabecular attenuation and by sagittal reconstruction for vertebral fracture assessment. We sought to combine this dual evaluation on the sagittal reconstruction alone to improve efficiency.

Methods

Routine contrast-enhanced abdominal CT scans performed for any indication on 571 consecutive adults age 60 years or older (mean age 70.7 years) were retrospectively analyzed. These were performed at a single center over a 3-month period. L1 trabecular attenuation was measured using an ovoid region-of-interest on both the transverse and sagittal series. The sagittal reconstruction was also analyzed for moderate-to-severe vertebral compression fractures using the Genant visual semi-quantitative method. Likely osteoporosis was defined by a moderate-to-severe fracture and/or sagittal L1 trabecular attenuation of ≤110 Hounsfield units (HU) (previously found to be >90 % specific for osteoporosis on our calibrated GE CT scanners at 120 kVp). Correlation was made with hip and spine dual X-ray absorptiometry (DXA).

Results

Mean absolute difference in L1 trabecular attenuation between transverse and sagittal reconstructions was 6.7 HU (±5.7) or 6.2 %. The transverse and sagittal HU measurements were in agreement (i.e., both measurements above or below this threshold) in 94.5 % of cases at the 110-HU cutoff. A total of 243 (42.3 %) patients had likely osteoporosis by CT criteria, of which only 48 (19.8 %) had previous DXA screening.

Conclusion

Assessment of the sagittal view alone at routine abdominal CT for both vertebral fractures and trabecular bone mineral density provides a rapid and effective opportunistic screen for detecting individuals at increased risk for fragility fractures.

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References

  1. Raisz LG (2005) Screening for osteoporosis. N Engl J Med 353:164–171

    Article  CAS  PubMed  Google Scholar 

  2. Calonge N, Bibbins-Domingo K, Cantu AG et al (2011) Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 154:356–U131

    Article  Google Scholar 

  3. Bone Health and Osteoporosis (2004) A report of the surgeon general. Rockville, MD: US Department of Health and Human Services Office of the Surgeon General

  4. King AB, Fiorentino DM (2011) Medicare payment cuts for osteoporosis testing reduced use despite tests’ benefit in reducing fractures. Health Aff 30:2362–2370

    Article  Google Scholar 

  5. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  CAS  PubMed  Google Scholar 

  6. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteop Int : J Estab Res Coop Between Europ Found Osteop Natl Osteop Found USA 11:556–561

    Article  CAS  Google Scholar 

  7. Ebeling PR (2008) Osteoporosis in men. N Engl J Med 358:1474–1482

    Article  CAS  PubMed  Google Scholar 

  8. Abraham A (2003) Undertreatment of osteoporosis in men who have had a hip fracture. Arch Intern Med 163:1236, author reply −7

    Article  PubMed  Google Scholar 

  9. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222

    Article  PubMed  Google Scholar 

  10. Wilkins CH, Goldfeder JS (2004) Osteoporosis screening is unjustifiably low in older African-American women. J Natl Med Assoc 96:461–467

    PubMed  PubMed Central  Google Scholar 

  11. 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. 2013;158:588--595

  12. 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 26:2194–2203

    Article  PubMed  PubMed Central  Google Scholar 

  13. Summers RM, Baecher N, Yao J et al (2011) Feasibility of simultaneous computed tomographic colonography and fully automated bone mineral densitometry in a single examination. J Comput Assist Tomogr 35:212–216

    Article  PubMed  PubMed Central  Google Scholar 

  14. IMV (2011) CT market outlook report. IMV Medical Information Division, Des Plaines

    Google Scholar 

  15. Carberry GA, Pooler BD, Binkley N, Lauder TB, Bruce RJ, Pickhardt PJ (2013) Unreported vertebral body compression fractures at abdominal multidetector CT. Radiology 268:120–126

    Article  PubMed  Google Scholar 

  16. Genant HK, Wu CY, Vankuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  CAS  PubMed  Google Scholar 

  17. Pickhardt P, Bodeen G, Brett A, Brown JK, Binkley N (2014) Comparison of femoral neck BMD evaluation obtained using lunar DXA and QCT with asynchronous calibration from CT colonography. J Clin Densitometr: Off J Int Soc Clin Densitometr. doi:10.1016/j.jocd.2014.03.002

    Google Scholar 

  18. Kennedy OD, Brennan O, Rackard SM, O’Brien FJ, Taylor D, Lee TC (2009) Variation of trabecular microarchitectural parameters in cranial, caudal and mid-vertebral regions of the ovine L3 vertebra. J Anat 214:729–735. doi:10.1111/j.1469-7580.2009.01054.x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ebbesen EN, Thomsen JS, Beck-Nielsen H, Nepper-Rasmussen HJ, Mosekilde L (1999) Age- and gender-related differences in vertebral bone mass, density, and strength. J Bone Miner Res 14:1394–1403

    Article  CAS  PubMed  Google Scholar 

  20. Lamba R, McGahan JP, Corwin MT (2014) CT Hounsfield numbers of soft tissues on unenhanced abdominal CT scans: variability between two different manufacturers’ MDCT scanners. AJR 203:1013–1020

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Kanis JA, McCloskey EV, Johansson H et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteop Int 24:23–57

    Article  CAS  Google Scholar 

  23. Siris E, Adler R, Bilezikian J et al (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteop Int 25:1439–1443

    Article  CAS  Google Scholar 

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Conflicts of interest

Dr. Pickhardt is co-founder of VirtuoCTC, shareholder in Cellectar Biosciences and consultant for Check-Cap; Scott Lee, Neil Binkley, Meghan Lubner, Richard Bruce, and Timothy Ziemlewicz declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA

    S. J. Lee, M. G. Lubner, R. J. Bruce, T. J. Ziemlewicz & P. J. Pickhardt

  2. Department of Medicine, Divisions of Endocrinology and Geriatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    N. Binkley

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  1. S. J. Lee
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  2. N. Binkley
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  3. M. G. Lubner
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  4. R. J. Bruce
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  5. T. J. Ziemlewicz
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  6. P. J. Pickhardt
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Correspondence to P. J. Pickhardt.

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Lee, S.J., Binkley, N., Lubner, M.G. et al. 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 (2016). https://doi.org/10.1007/s00198-015-3318-4

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  • DOI: https://doi.org/10.1007/s00198-015-3318-4

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