Department of Rheumatology, INSERM UMR 1153, APHP. Centre-Université de Paris, Institut de Recherche des Maladies Ostéo-Articulaires de l'Université de Paris, Hôpital Cochin.
AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901.
Rheumatology (Oxford). 2022 Aug 3;61(8):3269-3278. doi: 10.1093/rheumatology/keab878.
Osteoporosis is underdiagnosed and undertreated, although severe complications of osteoporotic fractures, including vertebral fractures, are well known. This study sought to assess the feasibility and results of an opportunistic screening of vertebral fractures and osteoporosis in a large database of lumbar or abdominal CT scans.
Data were analysed from CT scans obtained in 35 hospitals from patients aged 60 years or older and stored in a Picture Archiving and Communication System in Assistance-Publique-Hôpitaux de Paris, from 2007 to 2013. Dedicated software was used to analyse the presence or absence of at least 1 vertebral fracture (VF), and the radiodensity of the lumbar vertebrae was measured Hounsfield Units (HUs). A simulated T-score was calculated.
Data were analysed from 152 268 patients [mean age (S.D.) = 73.2 (9.07) years]. Success rates for VF assessment and HUs measurements were 82 and 87%, respectively. The prevalence of VFs was 24.5% and increased with age. Areas under the receiver operating characteristic curves for the detection of VFs were 0.61 and 0.62 for the mean HUs of the lumbar vertebrae and the L1 HUs, respectively. In patients without VFs, HUs decreased with age, similarly in males and females. The prevalence of osteoporosis (sT-score ≤ -2.5) was 23.8% and 36.5% in patients without and with VFs, respectively.
It is feasible on a large scale to screen for VFs and osteoporosis during opportunistic screening in patients 60 years or older having lumbar or abdominal CT.
尽管人们熟知骨质疏松性骨折的严重并发症，包括椎体骨折，但骨质疏松症的诊断和治疗仍严重不足。本研究旨在评估在巴黎公立医院 Assistance-Publique-Hôpitaux 大容量的腰椎或腹部 CT 扫描数据库中，对椎体骨折和骨质疏松症进行机会性筛查的可行性和结果。
对 2007 年至 2013 年期间，来自 Assistance-Publique-Hôpitaux de Paris 的 35 家医院的 60 岁及以上患者的 CT 扫描数据进行分析，这些数据存储在一个图像存档和通信系统中。专用软件用于分析是否存在至少 1 处椎体骨折（VF），并测量腰椎的 X 光密度单位（HU）。模拟 T 评分进行计算。
对 152268 例患者的数据进行了分析[平均年龄（标准差）=73.2（9.07）岁]。VF 评估和 HU 测量的成功率分别为 82%和 87%。VF 的患病率为 24.5%，且随年龄增长而增加。腰椎平均 HU 和 L1 HU 检测 VF 的受试者工作特征曲线下面积分别为 0.61 和 0.62。在没有 VF 的患者中，HU 值随年龄的增长而降低，男性和女性的情况相似。无 VF 的患者中，骨质疏松症（sT 评分≤-2.5）的患病率分别为 23.8%和 36.5%。
在 60 岁及以上接受腰椎或腹部 CT 检查的患者中，通过机会性筛查大规模筛查 VF 和骨质疏松症是可行的。
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