Advertisement

Archives of Osteoporosis

, 13:76 | Cite as

Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population

  • Yan-Lin LiEmail author
  • Kin-Hoi Wong
  • Martin Wai-Ming Law
  • Benjamin Xin-Hao Fang
  • Vince Wing-Hang Lau
  • Vince Varut Vardhanabuti
  • Victor Kam-Ho Lee
  • Andrew Kai-Chun Cheng
  • Wai-Yin Ho
  • Wendy Wai-Man Lam
Original Article
  • 108 Downloads

Abstract

Summary

This study assessed the possibility of diagnosing and excluding osteoporosis with routine abdominal CT scans in a Chinese population who underwent both DXA and CT for unrelated reasons. Statistical correlation was made between the HU measured of the spine on CT and various parameters on DXA. Diagnostic cutoff points in terms of HU were established for the diagnosis (≤ 136 HU) and exclusion (≥ 175 HU) of osteoporosis on sagittal reformatted images. There was excellent positive and negative predictive value for the DXA-defined diagnostic subgroups and were also comparable with previous studies in Caucasian populations. The authors exhort radiologists to report these incidental findings to facilitate early detection and treatment of osteoporosis in unsuspecting patients to prevent fractures and related complications.

Purpose

The suspicion for osteoporosis can be raised in diagnostic computed tomography of the abdomen performed for other indications. We derived cutoff thresholds for the attenuation value of the lumbar spinal vertebrae (L1–5) in Hounsfield units (HU) in a Chinese patient population to facilitate implementation of opportunistic screening in radiologists.

Methods

We included 109 Chinese patients who concomitantly underwent abdominal CT and dual X-ray absorptiometry (DXA) within 6 months between July 2014 and July 2017 at a university hospital in Hong Kong. Images were retrospectively reviewed on sagittal reformats, and region-of-interest (ROI) markers were placed on the anterior portion of each of the L1–L5 vertebra to measure the HU. The mean values of CT HU were then compared with the bone mineral density (BMD) and T-score obtained by DXA. Receiver operator characteristic (ROC) curves were generated to determine diagnostic cutoff thresholds and their sensitivity and specificity values.

Results

The mean CT HU differed significantly (p < 0.01) for the three DXA-defined BMD categories of osteoporosis (97 HU), of osteopenia (135 HU), and of normal individuals (230 HU). There was good correlation between the mean CT HU and BMD and T-score (Pearson coefficient of 0.62 and 0.61, respectively, p < 0.001). The optimal cutoff point for exclusion of osteoporosis or osteopenia was HU ≥ 175 with negative predictive value as 98.9% and with area under curve (AUC) of ROC curve as 0.97. The optimal cutoff point for diagnosis of osteoporosis was HU ≤ 136 with positive predictive value as 81.2% and with AUC of ROC curve as 0.86.

Conclusion

This is the first study on osteoporosis diagnosis with routine CT abdominal scans in Chinese population. The cutoff values were comparable with previous studies in Caucasian populations suggesting generalizability. Radiologists should consider routinely reporting these opportunistic findings to facilitate early detection and treatment of osteoporosis to prevent fractures and related complications.

Keywords

Opportunistic screening Osteoporosis Abdominal CT 

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Pickhardt PJ, Pooler BD, Lauder T et al (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595.  https://doi.org/10.7326/0003-4819-158-8-201304160-00003 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, Bessant J, Brown JP (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19:79–86.  https://doi.org/10.1007/s00198-007-0426-9 CrossRefPubMedGoogle Scholar
  3. 3.
    Nayak S, Roberts MS, Greenspan SL (2011) Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Ann Intern Med 155:751–761.  https://doi.org/10.7326/0003-4819-155-11-201112060-00007 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bow CB, Cheung E, Cheung CL et al (2012) Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 23:879–885.  https://doi.org/10.1007/s00198-011-1627-9 CrossRefPubMedGoogle Scholar
  5. 5.
    Cheung EYN, Tan KCB, Cheung CL, Kung AWC (2016) Osteoporosis in East Asia: current issues in assessment and management. Osteoporosis and Sarcopenia 2:118–133.  https://doi.org/10.1016/j.afos.2016.07.001 CrossRefGoogle Scholar
  6. 6.
    Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM (2017) Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 99:1580–1590.  https://doi.org/10.2106/JBJS.16.00749. CrossRefPubMedGoogle Scholar
  7. 7.
    Alacreu E, Moratal D, Arana E (2017) Opportunistic screening for osteoporosis by routine CT in southern Europe. Osteoporos Int 28:983–990.  https://doi.org/10.1007/s00198-016-3804-3 CrossRefPubMedGoogle Scholar
  8. 8.
    Lee SJ, Anderson PA, Pickhardt PJ (2017) Predicting future hip fractures on routine abdominal CT using opportunistic osteoporosis screening measures: a matched case-control study. AJR 207:395–402.  https://doi.org/10.2214/AJR.17.17820 CrossRefGoogle Scholar
  9. 9.
    Graffy PM, Lee SJ, Ziemlewicz TJ, Pickhard PJ (2017) Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR 209:491–496.  https://doi.org/10.2214/AJR.17.17853 CrossRefPubMedGoogle Scholar
  10. 10.
    Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ (2016) 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.  https://doi.org/10.1007/s00198-015-3318-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Schreiber JJ, Anderson PA, Ross HG et al (2011) Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am 93:1057–1063.  https://doi.org/10.2106/JBJS.J.00160 CrossRefPubMedGoogle Scholar
  12. 12.
    Unnanuntana, Gladnick BP, Donnelly E et al (2010) The assessment of fracture risk. J Bone Joint Surg Am 92:743–753.  https://doi.org/10.2106/JBJS.I.00919 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    HORIZON™ QDR® Series Fan Beam X-Ray bone densitometer technical manual, September 2013. Document MAN-03310 Revision 001Google Scholar
  14. 14.
    World Health Organization. WHO Scientific Group on the assessment of osteoporosis at primary health care level: Summary meeting report; May 5–7, 2004, Brussels, Belgium. Geneva, Switzerland: World Health Organization, 2007; 1–17. Last accessed: 25/Feb/2018. https://www.who.int/chp/topics/Osteoporosis.pdf
  15. 15.
    DeLong ER, DeLong DM, Clark-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefGoogle Scholar
  16. 16.
    Knowles NK, Reeves JM, Ferreira LM (2016) Quantitative computed tomography (QCT) derived bone mineral density (BMD) in finite element studies: a review of the literature. J Exp Orthop 3:36.  https://doi.org/10.1186/s40634-016-0072-2 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ziemlewicz TJ, Maciejewski A, Binkley N, Brett AD, Brown JK, Pickhardt PJ (2016) Direct comparison of unenhanced and contrast-enhanced CT for opportunistic proximal femur bone mineral density measurement: implications for csteoporosis screening. AJR 206:694–698.  https://doi.org/10.2214/AJR.15.15128 CrossRefPubMedGoogle Scholar
  18. 18.
    Pickhardt PJ, Lauder T, Pooler BD, Muñoz del Rio A, Rosas H, Bruce RJ, Binkley N (2016) Effect of IV contrast on lumbar trabecular attenuation at routine abdominal CT: correlation with DXA and implications for opportunistic osteoporosis screening. Osteoporos Int 27:147–152.  https://doi.org/10.1007/s00198-015-3224-9 CrossRefPubMedGoogle Scholar
  19. 19.
    Ziemlewicz TJ, Maciejewski A, Binkley N, Brett AD, Brown JK, Pickhardt PJ (2016) Opportunistic quantitative CT bone mineral density measurement at the proximal femur using routine contrast-enhanced scans: direct comparison with DXA in 355 adults. J Bone Miner Res 31:1835–1840.  https://doi.org/10.1002/jbmr.2856 CrossRefPubMedGoogle Scholar
  20. 20.
    Nam H-S, Shin M-H, Zmuda JM, Leung PC et al (2010) Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 21:2115–2123.  https://doi.org/10.1007/s00198-010-1188-3 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    United States Preventive Services Task Force (USPSTF) for osteoporosis screening, release date: January 2011. Last accessed: 18/March/2018. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening
  22. 22.
    Amarnath AL, Franks P, Robbins JA, Xing G, Fenton JJ (2015) Underuse and overuse of osteoporosis screening in a regional health system: a retrospective cohort study. J Gen Intern Med 30:1733–1740.  https://doi.org/10.1007/s11606-015-3349-8 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Yan-Lin Li
    • 1
    Email author
  • Kin-Hoi Wong
    • 1
    • 2
  • Martin Wai-Ming Law
    • 1
  • Benjamin Xin-Hao Fang
    • 1
  • Vince Wing-Hang Lau
    • 1
  • Vince Varut Vardhanabuti
    • 1
    • 3
  • Victor Kam-Ho Lee
    • 1
  • Andrew Kai-Chun Cheng
    • 1
  • Wai-Yin Ho
    • 1
  • Wendy Wai-Man Lam
    • 1
  1. 1.Department of RadiologyQueen Mary HospitalHong KongHong Kong
  2. 2.Department of RadiologyNorth District HospitalHong KongHong Kong
  3. 3.Department of Diagnostic RadiologyUniversity of Hong KongHong KongHong Kong

Personalised recommendations