CT May Help With Site-Specific Osteoporosis

To what extent can computed tomography (CT) be used to determine bone quality? And what is the relationship between dual x-ray absorptiometry (DXA) and diagnostic CT? A team of researchers from Hospital for Special Surgery (HSS), Raleigh Orthopaedic Clinic and New York Presbyterian Hospital joined forces to dig into these topics.

Their work, “Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment: A Qualitative Systematic Review,” appears in the September 20, 2017 edition of The Journal of Bone and Joint Surgery.

Joseph Lane, M.D. orthopedic trauma surgeon at HSS and a co-author on the study, told OTW, “There are insufficient DEXAs performed. The CT can provide similar information and thus when performed for whatever reason, it should also provide bone mass information.”

The authors wrote, “A systematic review of the MEDLINE [Medical Literature Analysis and Retrieval System Online] database was performed in February 2016 using the PubMed interface…Thirty-seven studies that reported on a total of 9,109 patients were included. Of these, 10 studies correlated HU [Hounsfield unit] measurements of trabecular bone with DXA-based bone assessment…”

“Direct HU measurement from diagnostic CT scans has the potential to be used opportunistically for osteoporosis screening, but in its current state it is not ready for clinical implementation. There is a lack of exchangeability among different machines that limits its broad applicability.”

Dr. Lane told OTW, “We found site dependent data that correlates well with DXA. There is a need for standardized methods across various machines. We need to set clear levels for osteopenia and osteoporosis for multiple sites in the body. Orthopedic surgeons should follow the literature. This method offers an easy route to determine local bone mass and should be used by the orthopedist to set the kind of operation.”