Correlation between Forearm Bone Mineral Density Measured by Dual Energy X-ray Absorptiometry and Hounsfield Units Value Measured by CT in Lumbar Spine

Abstract

Background Our aim was to determine if the dual-energy X-ray absorptiometry (DXA)-measured forearm bone mineral density (BMD) correlates with the Hounsfield unit (HU) values obtained from computed tomography (CT).

Methods A retrospective analysis of 164 patients with degenerative diseases of the lumbar spine was performed. DXA was used to measure the BMD and T-scores of each patient’s forearm. Lumbar CT was used to measure the CT HU values in three axial images of the L1–L4 vertebral bodies, and the average was calculated. According to the preoperative DXA T-score, they were divided into a normal group, an osteopenia group, and an osteoporosis group. Pearson’s correlation coefficient was used to analyze the correlations of CT HU values in L1–L4 with BMD and T-scores in the corresponding vertebral body. The receiver operating characteristic curve (ROC) was used to determine the CT HU thresholds between osteoporosis and non-osteoporosis groups.

Results Forearm BMD was moderately correlated with L1–L4 CT HU values (0.4 < R² < 0.6), and the correlation coefficients (R²) were 0.552, 0.578, 0.582, and 0.577, respectively (all p < 0.001). Forearm T-scores were moderately correlated with L1–L4 CT HU values (0.4 < R² < 0.6), and the correlation coefficients (R²) were 0.595, 0.609, 0.605, and 0.605, respectively (all p < 0.001). The thresholds of L1–L4 between the osteoporosis group (t ≤ -2.5) and the non-osteoporosis group (t > −2.5) were 110.0 HU (sensitivity 74% and specificity 76%), 112.5 HU (sensitivity 67% and 83% specificity), 92.4 HU (81% sensitivity and 70% specificity), and 98.7 HU (74% sensitivity and 78% specificity), respectively.

Conclusions Based on the moderate positive correlation between forearm DXA-measured BMD and HU values, forearm DXA provides a theoretical basis for evaluating lumbar vertebral bone mass. Preoperative forearm DXA may be useful in the formulation of surgical plans and the prevention of postoperative complications in patients with lumbar degenerative diseases.

Zusammenfassung

Hintergrund Unser Ziel war es, festzustellen, ob die Knochenmineraldichte (BMD) des Unterarms, gemessen mit der Dual-Röntgen-Absorptiometrie (DXA), mit den Werten der Hounsfield-Einheit (HU) aus der Computertomografie (CT) korreliert.

Methoden Es wurde eine retrospektive Analyse von 164 Patienten mit degenerativen Erkrankungen der Lendenwirbelsäule durchgeführt. DXA wurde verwendet, um BMD und T-Wert des Unterarms jedes Patienten zu messen. Lumbale CT wurde verwendet, um die CT-HU-Werte der L1–L4-Wirbelkörper in drei axialen Bildern zu messen, und der Durchschnitt wurde berechnet. Gemäß dem präoperativen DXA-T-Wert wurden die Patienten in eine Normalgruppe, eine Osteopenie-Gruppe und eine Osteoporose-Gruppe eingeteilt. Der Korrelationskoeffizient nach Pearson wurde verwendet, um die Korrelationen der CT-HU-Werte in L1–L4 mit BMD und T-Werten in den entsprechenden Wirbelkörpern zu analysieren. Die Receiver Operating Characteristic-Kurve (ROC-Kurve) wurde verwendet, um die CT-HU-Schwellenwerte zwischen Osteoporose- und Nicht-Osteoporose-Gruppen zu bestimmen.

Ergebnisse Die Unterarm-BMD korrelierte moderat mit L1–L4-CT-HU-Werten (0,4 < R² < 0,6), und die Korrelationskoeffizienten (R²) betrugen 0,552, 0,578, 0,582 bzw. 0,577 (alle p < 0,001). Die Unterarm-T-Werte korrelierten moderat mit den L1–L4-CT-HU-Werten (0,4 < R² < 0,6) und die Korrelationskoeffizienten (R²) betrugen 0,595, 0,609, 0,605 bzw. 0,605 (alle p < 0,001). Die Schwellenwerte von L1–L4 zwischen der Osteoporose-Gruppe (t ≤ –2,5) und der Nicht-Osteoporose-Gruppe (t > −2,5) betrugen 110,0 HU (Sensitivität 74% und Spezifität76%), 112,5 HU (Sensitivität 67% und 83% Spezifität), 92,4 HU (81% Sensitivität und 70% Spezifität) bzw. 98,7 HU (74% Sensitivität und 78% Spezifität).

Schlussfolgerung Aufgrund der moderaten positiven Korrelation zwischen den mit der Unterarm-DXA gemessenen BMD und HU-Werten bietet die Unterarm-DXA eine theoretische Grundlage für die Bewertung der Knochenmasse der Lendenwirbelsäule. Daher kann die präoperative Unterarm-DXA bei der Formulierung von Operationsplänen und der Prävention postoperativer Komplikationen bei Patienten mit lumbalen degenerativen Erkrankungen nützlich sein.

Keywords

osteoporosis - CT Hounsfield unit value · - dual-energy X-ray absorptiometry - forearm - lumbar degenerative disease

Schlüsselwörter

Osteoporose - CT Hounsfield-Einheitswert - Dual-Energy-Röntgen-Absorptiometrie - Unterarm - lumbale degenerative Erkrankung

Publication History

Received: 19 May 2022

Accepted after revision: 21 November 2022

Article published online:
31 January 2023

• References

• 1 Zeng Q, Li N, Wang QQ. et al. The Prevalence of Osteoporosis in China, a Nationwide, Multicenter DXA Survey. J Bone Miner Res 2019; 34: 1789-1797 DOI: 10.1002/jbmr.3757. (PMID: 31067339)
• 2 Cui ZY, Meng XY, Feng H. et al. Estimation and projection about the standardized prevalence of osteoporosis in mainland China. Arch Osteoporos 2019; 15: 2 DOI: 10.1007/s11657-019-0670-6.
• 3 Chin DK, Park JY, Yoon YS. et al. Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int 2007; 18: 1219-1224 DOI: 10.1007/s00198-007-0370-8. (PMID: 17387420)
• 4 Cho JH, Hwang CJ, Kim H. et al. Effect of osteoporosis on the clinical and radiological outcomes following one-level posterior lumbar interbody fusion. J Orthop Sci 2018; 23: 870-877 DOI: 10.1016/j.jos.2018.06.009. (PMID: 30431006)
• 5 Prost S, Pesenti S, Fuentes S. et al. Treatment of osteoporotic vertebral fractures. Orthop Traumatol Surg Res 2021; 107: 102779 DOI: 10.1016/j.otsr.2020.102779. (PMID: 33321233)
• 6 Ensrud KE, Crandall CJ. Osteoporosis. Ann Intern Med 2017; 167: ITC17-ITC31 DOI: 10.7326/aitc201708010. (PMID: 28761958)
• 7 Muraki S, Yamamoto S, Ishibashi H. et al. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 2004; 15: 724-728 DOI: 10.1007/s00198-004-1600-y. (PMID: 14997287)
• 8 Pouillès J, Tremollières F, Martinez S. et al. Ability of peripheral DXA measurements of the forearm to predict low axial bone mineral density at menopause. Osteoporos Int 2001; 12: 71-76 DOI: 10.1007/s001980170160. (PMID: 11305086)
• 9 Frisoli A, Paes A, Kimura A. et al. Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study. Bone Rep 2021; 15: 101134 DOI: 10.1016/j.bonr.2021.101134.
• 10 Stojanovic OI, Vuceljic M, Lazovic M. et al. Bone mineral density at different sites and vertebral fractures in Serbian postmenopausal women. Climacteric 2017; 20: 37-43 DOI: 10.1080/13697137.2016.1253054.
• 11 Li YL, Wong KH, Law MWM. et al. Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population. Arch Osteoporos 2018; 13: 76 DOI: 10.1007/s11657-018-0492-y. (PMID: 29987388)
• 12 Pickhardt PJ, Pooler BD, Lauder T. et al. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 2013; 158: 588-595 DOI: 10.7326/0003-4819-158-8-201304160-00003.
• 13 Zou D, Li WS, Deng C. et al. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J 2019; 28: 1758-1766 DOI: 10.1007/s00586-018-5776-9.
• 14 Zou D, Muheremu A, Sun ZR. et al. Computed tomography Hounsfield unit-based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease. J Neurosurg Spine 2020; 32: 716-721 DOI: 10.3171/2019.11.Spine19868. (PMID: 31899883)
• 15 Bokov A, Bulkin A, Aleynik A. et al. Pedicle Screws Loosening in Patients With Degenerative Diseases of the Lumbar Spine: Potential Risk Factors and Relative Contribution. Global Spine J 2019; 9: 55-61 DOI: 10.1177/2192568218772302.
• 16 Anderson PA, Jeray KJ, Lane JM. et al. Bone Health Optimization: Beyond Own the Bone: AOA Critical Issues. J Bone Joint Surg Am 2019; 101: 1413-1419 DOI: 10.2106/JBJS.18.01229. (PMID: 31393435)
• 17 Maurer E, Bahrs C, Kühle L. et al. Comparability of Patient-reported Outcome Measures and Clinical Assessment Tools for Shoulder Function in Patients with Proximal Humeral Fracture. Z Orthop Unfall 2021; 159: 638-648 DOI: 10.1055/a-1200-2797.
• 18 Wagner SC, Formby PM, Helgeson MD. et al. Diagnosing the Undiagnosed: Osteoporosis in Patients Undergoing Lumbar Fusion. Spine (Phila Pa 1976) 2016; 41: E1279-E1283 DOI: 10.1097/BRS.0000000000001612. (PMID: 27802255)
• 19 Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir (Wien) 2016; 158: 1421-1427 DOI: 10.1007/s00701-016-2821-5. (PMID: 27177734)
• 20 Zou D, Jiang S, Zhou S. et al. Prevalence of Osteoporosis in Patients Undergoing Lumbar Fusion for Lumbar Degenerative Diseases: A Combination of DXA and Hounsfield Units. Spine (Phila Pa 1976) 2020; 45: E406-E410 DOI: 10.1097/BRS.0000000000003284. (PMID: 31725127)
• 21 Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 2007; 83: 509-517 DOI: 10.1136/pgmj.2007.057505. (PMID: 17675543)
• 22 Rey P, Sornay-Rendu E, Garnero P. et al. Measurement of forearm bone mineral density by X-ray absorptiometry: Comparison with other skeletal sites. Rev Rhum Ed Fr 1994; 61: 548-554
• 23 Eftekhar-Sadat B, Ghavami M, Toopchizadeh V. et al. Wrist bone mineral density utility in diagnosing hip osteoporosis in postmenopausal women. Ther Adv Endocrinol Metab 2016; 7: 207-211 DOI: 10.1177/2042018816658164. (PMID: 28203357)
• 24 Lee S, Chung CK, Oh SH. et al. Correlation between Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry and Hounsfield Units Measured by Diagnostic CT in Lumbar Spine. J Korean Neurosurg Soc 2013; 54: 384-389 DOI: 10.3340/jkns.2013.54.5.384.
• 25 Nam HS, Shin MH, Zmuda JM. et al. Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 2010; 21: 2115-2123 DOI: 10.1007/s00198-010-1188-3. (PMID: 20204598)
• 26 Yang P, Lu Y, Khoo CM. et al. Associations between ethnicity, body composition, and bone mineral density in a Southeast Asian population. J Clin Endocrinol Metab 2013; 98: 4516-4523 DOI: 10.1210/jc.2013-2454.
• 27 Kim YS, Han JJ, Lee J. et al. The correlation between bone mineral density/trabecular bone score and body mass index, height, and weight. Osteoporos Sarcopenia 2017; 3: 98-103 DOI: 10.1016/j.afos.2017.02.001.
• 28 Song J, Zhang R, Lv L. et al. The Relationship Between Body Mass Index and Bone Mineral Density: A Mendelian Randomization Study. Calcif Tissue Int 2020; 107: 440-445 DOI: 10.1007/s00223-020-00736-w.