Abstract
Background: Hounsfield Units (HU) values derived from Computerized Tomography (CT) have been used in the diagnosis of osteoporosis in the lumbar spine.
Objective: This study aimed to identify anatomical dimensions of lumbar vertebrae on CT images, which were different between older normal, osteopenic, and osteoporotic subjects.
Methods: This prospective pilot study enrolled 79 older adults. Based on CT measurements of lumbar vertebrae in HU, participants were classified into three groups: normal (HU > 109), osteopenia (HU: 94-108), and osteoporosis (HU < 93). Altogether, 42 anatomical variables of lumbar vertebrae, L2, L3, L4, and L5, were measured in each participant by CT, including 24 parameters measurable by MRI or plain X-ray and 18 parameters measurable by MRI only.
Results: Among the morphological measurements also measurable by MRI and plain X-ray, the length upper curve, 50% and 75% of L5, length upper with the cortex of L4, length center of the cortex of L3, as well as width upper curve 75% of L2, were significantly different between the three groups (p= 0.008, 0.007, 0.035, 0.036, and 0.003 respectively). Among the morphological measurements also measurable by MRI, only the width upper cortex 75% of L5 and the width lower cortex 25% of L3, were significantly different between the three groups (p= 0.031 and 0.020, respectively).
Conclusion: Seven CT morphological measurements may be used as “reference standard” CT measurements for preliminarily diagnosing osteoporosis and osteopenia in older adults.
Keywords: Bone mineral density, computerized tomography, lumbar vertebrae, morphology, osteoporosis, older adults.
Graphical Abstract
[1]
Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteo-porosis epidemiology study. J Bone Miner Res 2004; 19(4): 532-6.
[http://dx.doi.org/10.1359/JBMR.040109] [PMID: 15005838]
[http://dx.doi.org/10.1359/JBMR.040109] [PMID: 15005838]
[2]
Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: A position statement from the National Bone Health Alliance Working Group. Osteoporos Int 2014; 25(5): 1439-43.
[http://dx.doi.org/10.1007/s00198-014-2655-z] [PMID: 24577348]
[http://dx.doi.org/10.1007/s00198-014-2655-z] [PMID: 24577348]
[3]
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 2007; 22(3): 465-75.
[http://dx.doi.org/10.1359/jbmr.061113] [PMID: 17144789]
[http://dx.doi.org/10.1359/jbmr.061113] [PMID: 17144789]
[4]
Cui LH, Choi JS, Shin MH, et al. Prevalence of osteoporosis and reference data for lumbar spine and hip bone mineral density in a Korean population. J Bone Miner Metab 2008; 26(6): 609-17.
[http://dx.doi.org/10.1007/s00774-007-0847-8] [PMID: 18979161]
[http://dx.doi.org/10.1007/s00774-007-0847-8] [PMID: 18979161]
[5]
Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int 2017; 28(6): 1979-88.
[http://dx.doi.org/10.1007/s00198-017-3996-1] [PMID: 28315954]
[http://dx.doi.org/10.1007/s00198-017-3996-1] [PMID: 28315954]
[6]
Pisani P, Renna MD, Conversano F, et al. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol 2013; 5(11): 398-410.
[http://dx.doi.org/10.4329/wjr.v5.i11.398] [PMID: 24349644]
[http://dx.doi.org/10.4329/wjr.v5.i11.398] [PMID: 24349644]
[7]
Mautalen C, Schianchi A, Sigal D, et al. Prevalence of osteoporosis in women in buenos aires based on bone mineral density at the lumbar spine and femur. J Clin Densitom 2016; 19(4): 471-6.
[http://dx.doi.org/10.1016/j.jocd.2016.01.003] [PMID: 26948141]
[http://dx.doi.org/10.1016/j.jocd.2016.01.003] [PMID: 26948141]
[8]
Tosun O, Fidan F, Erdil F, Tosun A. Karaoğlanoğlu M, Ardıçoğlu O. Assessment of lumbar vertebrae morphology by magnetic resonance imaging in osteoporosis. Skeletal Radiol 2012; 41(12): 1583-90.
[http://dx.doi.org/10.1007/s00256-012-1435-0] [PMID: 22592591]
[http://dx.doi.org/10.1007/s00256-012-1435-0] [PMID: 22592591]
[9]
Cortet B, Boutry N, Dubois P, Bourel P, Cotten A, Marchandise X. In vivo comparison between computed tomography and magnetic reso-nance image analysis of the distal radius in the assessment of osteoporosis. J Clin Densitom 2000; 3(1): 15-26.
[http://dx.doi.org/10.1385/JCD:3:1:015] [PMID: 10917740]
[http://dx.doi.org/10.1385/JCD:3:1:015] [PMID: 10917740]
[11]
Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: A tool for osteoporosis management. J Bone Joint Surg Am 2011; 93(11): 1057-63.
[http://dx.doi.org/10.2106/JBJS.J.00160] [PMID: 21655899]
[http://dx.doi.org/10.2106/JBJS.J.00160] [PMID: 21655899]
[12]
Lee S, Chung CK, Oh SH, Park SB. Correlation between bone mineral density measured by dual-energy X-ray absorptiometry and houns-field units measured by diagnostic CT in lumbar spine. J Korean Neurosurg Soc 2013; 54(5): 384-9.
[http://dx.doi.org/10.3340/jkns.2013.54.5.384] [PMID: 24379944]
[http://dx.doi.org/10.3340/jkns.2013.54.5.384] [PMID: 24379944]
[13]
Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degen-erative spine: Correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir (Wien) 2016; 158(7): 1421-7.
[http://dx.doi.org/10.1007/s00701-016-2821-5] [PMID: 27177734]
[http://dx.doi.org/10.1007/s00701-016-2821-5] [PMID: 27177734]
[14]
Zaidi Q, Danisa OA, Cheng W. Measurement techniques and utility of hounsfield unit values for assessment of bone quality prior to spinal instrumentation: A review of current literature. Spine 2019; 44(4): E239-44.
[http://dx.doi.org/10.1097/BRS.0000000000002813] [PMID: 30063528]
[http://dx.doi.org/10.1097/BRS.0000000000002813] [PMID: 30063528]
[15]
Kim KJ, Kim DH, Lee JI, Choi BK, Han IH, Nam KH. Hounsfield units on lumbar computed tomography for predicting regional bone min-eral density. Open Med (Wars) 2019; 14(1): 545-51.
[http://dx.doi.org/10.1515/med-2019-0061] [PMID: 31410366]
[http://dx.doi.org/10.1515/med-2019-0061] [PMID: 31410366]
[16]
Emohare O, Cagan A, Morgan R, et al. The use of computed tomography attenuation to evaluate osteoporosis following acute fractures of the thoracic and lumbar vertebra. Geriatr Orthop Surg Rehabil 2014; 5(2): 50-5.
[http://dx.doi.org/10.1177/2151458514525042] [PMID: 25360331]
[http://dx.doi.org/10.1177/2151458514525042] [PMID: 25360331]
[17]
Zou D, Li W, Deng C, Du G, Xu N. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J 2019; 28(8): 1758-66.
[http://dx.doi.org/10.1007/s00586-018-5776-9] [PMID: 30306332]
[http://dx.doi.org/10.1007/s00586-018-5776-9] [PMID: 30306332]
[18]
Hocaoglu E, Inci E, Vural M. Could computed tomography hounsfield unit values of lumbar vertebrae detect osteoporosis? Curr Med Imaging Rev 2021; 17(8): 988-95.
[http://dx.doi.org/10.2174/1573405617999210112193545] [PMID: 33438545]
[http://dx.doi.org/10.2174/1573405617999210112193545] [PMID: 33438545]
[19]
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.
[http://dx.doi.org/10.7326/0003-4819-158-8-201304160-00003] [PMID: 23588747]
[http://dx.doi.org/10.7326/0003-4819-158-8-201304160-00003] [PMID: 23588747]
[20]
Alacreu E, Moratal D, Arana E. Opportunistic screening for osteoporosis by routine CT in Southern Europe. Osteoporos Int 2017; 28(3): 983-90.
[http://dx.doi.org/10.1007/s00198-016-3804-3] [PMID: 28108802]
[http://dx.doi.org/10.1007/s00198-016-3804-3] [PMID: 28108802]
[21]
Ahmad Z, Mobasheri R, Das T, et al. How to interpret computed tomography of the lumbar spine. Ann R Coll Surg Engl 2014; 96(7): 502-7.
[http://dx.doi.org/10.1308/rcsann.2014.96.7.502] [PMID: 25245727]
[http://dx.doi.org/10.1308/rcsann.2014.96.7.502] [PMID: 25245727]
[22]
Albanese CV, De Terlizzi F, Passariello R. Quantitative ultrasound of the phalanges and DXA of the lumbar spine and proximal femur in evaluating the risk of osteoporotic vertebral fracture in postmenopausal women. Radiol Med (Torino) 2011; 116(1): 92-101.
[http://dx.doi.org/10.1007/s11547-010-0577-1] [PMID: 20927655]
[http://dx.doi.org/10.1007/s11547-010-0577-1] [PMID: 20927655]
[23]
Wu SY, Jia HH, Hans D, et al. Assessment of volumetric bone mineral density of the femoral neck in postmenopausal women with and without vertebral fractures using quantitative multi-slice CT. J Zhejiang Univ Sci B 2009; 10(7): 499-504.
[http://dx.doi.org/10.1631/jzus.B0820409] [PMID: 19585667]
[http://dx.doi.org/10.1631/jzus.B0820409] [PMID: 19585667]
[24]
Weaver AA, Beavers KM, Hightower RC, Lynch SK, Miller AN, Stitzel JD. Lumbar bone mineral density phantomless computed tomogra-phy measurements and correlation with age and fracture incidence. Traffic Inj Prev 2015; 16(Suppl. 2): S153-60.
[http://dx.doi.org/10.1080/15389588.2015.1054029] [PMID: 26436225]
[http://dx.doi.org/10.1080/15389588.2015.1054029] [PMID: 26436225]
[25]
Ward CM, Arnold MA, Emohare O. Characterizing bone mineral density using lumbar spine computed tomography attenuation in patients with distal radius fractures. Geriatr Orthop Surg Rehabil 2019; 10: 2151459319847408.
[http://dx.doi.org/10.1177/2151459319847408] [PMID: 31192025]
[http://dx.doi.org/10.1177/2151459319847408] [PMID: 31192025]
[26]
Lim HK, Ha HI, Park SY, Lee K. Comparison of the diagnostic performance of CT Hounsfield unit histogram analysis and dual-energy X-ray absorptiometry in predicting osteoporosis of the femur. Eur Radiol 2019; 29(4): 1831-40.
[http://dx.doi.org/10.1007/s00330-018-5728-0] [PMID: 30255256]
[http://dx.doi.org/10.1007/s00330-018-5728-0] [PMID: 30255256]
[27]
Na MK, Won YD, Kim CH, 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.
[http://dx.doi.org/10.1371/journal.pone.0197336] [PMID: 29746570]
[http://dx.doi.org/10.1371/journal.pone.0197336] [PMID: 29746570]
[28]
Huang CWC, Tseng IJ, Yang SW, Lin YK, Chan WP. Lumbar muscle volume in postmenopausal women with osteoporotic compression fractures: Quantitative measurement using MRI. Eur Radiol 2019; 29(9): 4999-5006.
[http://dx.doi.org/10.1007/s00330-019-06034-w] [PMID: 30847590]
[http://dx.doi.org/10.1007/s00330-019-06034-w] [PMID: 30847590]
[29]
Griffith JF, Yeung DK, Antonio GE, et al. Vertebral bone mineral density, marrow perfusion, and fat content in healthy men and men with osteoporosis: Dynamic contrast-enhanced MR imaging and MR spectroscopy. Radiology 2005; 236(3): 945-51.
[http://dx.doi.org/10.1148/radiol.2363041425] [PMID: 16055699]
[http://dx.doi.org/10.1148/radiol.2363041425] [PMID: 16055699]
[30]
Park SH, Jeong YM, Lee HY, et al. Opportunistic use of chest CT for screening osteoporosis and predicting the risk of incidental fracture in breast cancer patients: A retrospective longitudinal study. PLoS One 2020; 15(10): e0240084.
[http://dx.doi.org/10.1371/journal.pone.0240084] [PMID: 33052943]
[http://dx.doi.org/10.1371/journal.pone.0240084] [PMID: 33052943]
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