Perry J. Pickhardt, MD; B. Dustin Pooler, MD; Travis Lauder, BS; Alejandro Muñoz del Rio, PhD; Richard J. Bruce, MD; Neil Binkley, MD
Grant Support: By the National Institutes of Health (grants 1R01CA144835-01 and 1R01CA169331-01).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1803.
Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. Pickhardt (e-mail, email@example.com).
Requests for Single Reprints: Perry J. Pickhardt, MD, Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Pickhardt and Pooler, Mr. Lauder, and Drs. Muñoz del Rio and Bruce: Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3252.
Dr. Binkley: Divisions of Geriatrics and Endocrinology, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI 53705.
Author Contributions: Conception and design: P.J. Pickhardt, B.D. Pooler, R.J. Bruce, N. Winkler.
Analysis and interpretation of the data: P.J. Pickhardt, B.D. Pooler, A. Muñoz del Rio, R.J. Bruce, N. Winkler.
Drafting of the article: P.J. Pickhardt, B.D. Pooler, A. Muñoz del Rio.
Critical revision of the article for important intellectual content: P.J. Pickhardt, B.D. Pooler, A. Muñoz del Rio, R.J. Bruce, N. Winkler.
Final approval of the article: P.J. Pickhardt, B.D. Pooler, A. Muñoz del Rio, R.J. Bruce, N. Winkler.
Statistical expertise: B.D. Pooler, A. Muñoz del Rio.
Obtaining of funding: P.J. Pickhardt.
Administrative, technical, or logistic support: P.J. Pickhardt, R.J. Bruce.
Collection and assembly of data: P.J. Pickhardt, B.D. Pooler, T. Lauder, R.J. Bruce.
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;158:588-595. doi: 10.7326/0003-4819-158-8-201304160-00003
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Published: Ann Intern Med. 2013;158(8):588-595.
Osteoporosis is a prevalent but underdiagnosed condition.
To evaluate computed tomography (CT)–derived bone mineral density (BMD) assessment compared with dual-energy x-ray absorptiometry (DXA) measures for identifying osteoporosis by using CT scans performed for other clinical indications.
Single academic health center.
1867 adults undergoing CT and DXA (n = 2067 pairs) within a 6-month period over 10 years.
CT-attenuation values (in Hounsfield units [HU]) of trabecular bone between the T12 and L5 vertebral levels, with an emphasis on L1 measures (study test); DXA BMD measures (reference standard). Sagittal CT images assessed for moderate-to-severe vertebral fractures.
CT-attenuation values were significantly lower at all vertebral levels for patients with DXA-defined osteoporosis (P < 0.001). An L1 CT-attenuation threshold of 160 HU or less was 90% sensitive and a threshold of 110 HU was more than 90% specific for distinguishing osteoporosis from osteopenia and normal BMD. Positive predictive values for osteoporosis were 68% or greater at L1 CT-attenuation thresholds less than 100 HU; negative predictive values were 99% at thresholds greater than 200 HU. Among 119 patients with at least 1 moderate-to-severe vertebral fracture, 62 (52.1%) had nonosteoporotic T-scores (DXA false-negative results), and most (97%) had L1 or mean T12 to L5 vertebral attenuation of 145 HU or less. Similar performance was seen at all vertebral levels. Intravenous contrast did not affect CT performance.
The potential benefits and costs of using the various CT-attenuation thresholds identified were not formally assessed.
Abdominal CT images obtained for other reasons that include the lumbar spine can be used to identify patients with osteoporosis or normal BMD without additional radiation exposure or cost.
National Institutes of Health.
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Endocrine and Metabolism, Metabolic Bone Disorders, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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