Osteoporosis International

, Volume 29, Issue 2, pp 459–465 | Cite as

CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case-control analysis

  • D. Schönenberg
  • R. Guggenberger
  • D. Frey
  • H.-C. Pape
  • H.-P. Simmen
  • G. OsterhoffEmail author
Original Article



This matched case-control study compared the computed tomography (CT)-based regional bone density of patients with fragility fractures of the sacrum to a control without fracture. Patients with a sacral fracture demonstrated a significantly lower regional bone density of the sacrum, the sacral bone density not being correlated with the BMD by DXA of the spine.


The aim of this study is to compare the computed tomography-based regional bone density measured by Hounsfield units (HUs) in patients with and without fragility fractures of the sacrum.


Patients aged ≥ 50 years with a fragility fracture of the sacrum were compared to patients of similar age and gender who had a fall from standing height without fracture (n = 46). A matched case-control analysis was conducted by retrospective chart review and assessment of areal bone mineral density by lumbar DXA and by volumetric regional HU measurements in uncalibrated CT scans of the sacrum.


Patients with a sacral fracture (age 74 ± 11 years) showed a lower bone density in the body of S1 (HU 85 ± 22) when compared to the matched control group without fracture (age 73 ± 10 years, HU 125 ± 37, p < 0.001). The CT-based bone density of S1 did not correlate with the DXA values of the lumbar spine (r = 0.223, p = 0.136), and lumbar spine T-scores did not differ between the groups (− 2.0 ± 1.3 vs. − 1.9 ± 1.2, p = 0.786). All measurements are based on uncalibrated scans, and absolute HU values are restricted to scans made on Siemens SOMATOM Force or SOMATOM Edge scanners.


Patients with fragility fractures of the sacrum demonstrated a lower regional volumetric bone density of the sacrum when compared to a cohort without a fracture. Local sacral volumetric bone density as measured by CT seems to be independent from the areal BMD as measured by DXA of the lumbar spine.

Level of evidence: level III.


Computed tomography Dual-energy X-ray absorptiometry Hounsfield units Osteoporosis Pelvic fracture Sacral fracture 


Compliance with ethical standards

The protocol of the present study was approved by the local ethics committee (Kantonale Ethik-Kommission Zürich, KEK-ZH-Nr. 2016–01758).

Conflicts of interest


Supplementary material

198_2017_4307_MOESM1_ESM.docx (191 kb)
ESM 1 (DOCX 191 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • D. Schönenberg
    • 1
  • R. Guggenberger
    • 2
  • D. Frey
    • 3
  • H.-C. Pape
    • 1
  • H.-P. Simmen
    • 1
  • G. Osterhoff
    • 1
    Email author
  1. 1.Division of Trauma SurgeryUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of RheumatologyUniversity Hospital ZurichZurichSwitzerland

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