Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.
Department Wirbelsäule, Klinik für Orthopädie des Universitätsklinikums Jena, Campus Waldkkliniken Eisenberg, Eisenberg, Germany.
Spine (Phila Pa 1976). 2021 Jul 1;46(13):861-866. doi: 10.1097/BRS.0000000000003917.
Prospective cross-sectional exploratory study.
To evaluate the correlation between in vivo lumbar dual-energy x-ray absorptiometry (DXA) and parameters of bone architecture in micro-computed tomography (micro-CT) in patients with osteoporosis.
DXA is the current diagnostic standard for evaluating osteoporosis. However, there are various concerns regarding its validity, especially in the spine. No study has so far investigated whether in vivo DXA correlates with the actual lumbar bone architecture.
Lumbar DXA scans were compared with micro-CT analysis of vertebral biopsies in patients with osteoporotic vertebral fractures (fracture group) and those without (control group). Preoperatively, all patients underwent a DXA scan (L1-L4). Intraoperative biopsies from nonfractured vertebrae (preferably L3) were analyzed by micro-CT regarding bone quantity and quality. The groups were compared regarding differences in DXA and micro-CT results. In each group, a correlation analysis was performed between DXA and micro-CT.
The study included 66 patients (33 per group). Preoperative DXA results were worse in the fracture group than the control group (areal bone mineral density [aBMD] 0.95 vs. 1.31, T-score -1.97 vs. 0.92, each P < 0.001). Micro-CT analysis confirmed differences regarding quantitative parameters (bone/total volume: 0.09 vs. 0.12, P < 0.001) and qualitative parameters (connectivity index: 15.73 vs. 26.67, P < 0.001; structure model index: 2.66 vs. 2.27, P < 0.001; trabecular number: 2.11 vs. 2.28, P = 0.014) of bone architecture between both groups. The DXA results did not correlate with micro-CT parameters in the fracture group. In the control group, correlations were found for some parameters (bone/total volume vs. aBMD: r = 0.51, P = 0.005; trabecular number vs. aBMD: r = 0.56, P = 0.001).
These data constitute the first comparison of DXA measurements with microstructural analysis of vertebral biopsies in patients with osteoporosis. Our results indicate that lumbar DXA neither qualitatively nor quantitatively represents microstructural bone architecture and is therefore not a reliable tool for the evaluation of bone quality in the spine.Level of Evidence: 3.
前瞻性横断面探索性研究。
评估骨质疏松症患者体内腰椎双能 X 射线吸收法（DXA）与微计算机断层扫描（micro-CT）骨结构参数之间的相关性。
DXA 是目前评估骨质疏松症的诊断标准。然而，其有效性存在各种问题，特别是在脊柱方面。迄今为止，尚无研究调查体内 DXA 是否与实际腰椎骨结构相关。
将骨质疏松性椎体骨折患者（骨折组）和无骨折患者（对照组）的腰椎 DXA 扫描与椎体活检的 micro-CT 分析进行比较。所有患者术前均行 L1-L4 处 DXA 扫描。对非骨折椎体（最好为 L3）的术中活检进行 micro-CT 分析，以评估骨量和骨质量。比较两组间 DXA 和 micro-CT 结果的差异。在每组中，进行 DXA 和 micro-CT 之间的相关性分析。
本研究纳入 66 例患者（每组 33 例）。骨折组患者术前 DXA 结果较对照组差（面积骨密度[aBMD] 0.95 对 1.31，T 评分-1.97 对 0.92，均 P<0.001）。micro-CT 分析证实了定量参数（骨/总体积：0.09 对 0.12，P<0.001）和定性参数（连通指数：15.73 对 26.67，P<0.001；结构模型指数：2.66 对 2.27，P<0.001；骨小梁数量：2.11 对 2.28，P=0.014）之间存在差异。DXA 结果与骨折组的 micro-CT 参数无相关性。在对照组中，某些参数存在相关性（骨/总体积与 aBMD：r=0.51，P=0.005；骨小梁数量与 aBMD：r=0.56，P=0.001）。
这些数据首次比较了骨质疏松症患者的 DXA 测量值与椎体活检的微观结构分析。我们的结果表明，腰椎 DXA 既不能定性也不能定量地反映微观结构骨结构，因此不是评估脊柱骨质量的可靠工具。
3 级。
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