Divison of Endocrinology, Diabetes and Metabolism, University of California, Davis, USA.
Department of Orthopedic Surgery, University of California, Davis, USA.
Osteoporos Int. 2023 Mar;34(3):551-561. doi: 10.1007/s00198-022-06624-3. Epub 2022 Dec 29.
Osteoporosis care in men is suboptimal due to low rates of testing and treatment. Applying biomechanical computed tomography (BCT) analysis to existing CT scans, we found a high proportion of men with osteoporosis have never been diagnosed or treated. BCT may improve identification of patients at high risk of fracture.
Osteoporosis care in men is suboptimal due to low rates of DXA testing and treatment. Biomechanical computed tomography analysis (BCT) can be applied "opportunistically" to prior hip-containing CT scans to measure femoral bone strength and hip BMD.
In this retrospective, cross-sectional study, we used BCT in male veterans with existing CT scans to investigate the prevalence of osteoporosis, defined by hip BMD (T-score ≤ - 2.5) or fragile bone strength (≤ 3500 N). 577 men, age ≥ 65 with abdominal/pelvic CTs performed in 2017-2019, were randomly selected for BCT analysis. Clinical data were collected via electronic health records and used with the femoral neck BMD T-score from BCT to estimate 10-year hip fracture risks by FRAX.
Prevalence of osteoporosis by BCT increased with age (13.5% age 65-74; 18.2% age 75-84; 34.3% age ≥ 85), with an estimated overall prevalence of 18.3% for men age ≥ 65. In those with osteoporosis (n = 108/577), only 38.0% (41/108) had a prior DXA and 18.6% (7/108) had received osteoporosis pharmacotherapy. Elevated hip fracture risk by FRAX (≥ 3%) did not fully capture those with fragile bone strength. In a multivariate logistic regression model adjusted for age, BMI, race, and CT location, end stage renal disease (odds ratio 7.4; 95% confidence interval 2.3-23.9), COPD (2.2; 1.2-4.0), and high-dose inhaled corticosteroid use (3.7; 1.2-11.8) were associated with increased odds of having osteoporosis by BCT.
Opportunistic BCT in male veterans provides an additional avenue to identify patients who are at high risk of fractures.
由于 DXA 检测和治疗率低，男性骨质疏松症的护理效果并不理想。生物力学计算机断层扫描分析（BCT）可“偶然”应用于先前包含髋部 CT 扫描的图像，以测量股骨骨强度和髋部 BMD。
在这项回顾性、横断面研究中，我们使用 BCT 分析了 2017 年至 2019 年间进行腹部/盆腔 CT 检查的年龄≥65 岁的男性退伍军人中骨质疏松症的患病率，骨质疏松症的定义为髋部 BMD（T 评分≤-2.5）或脆弱骨强度（≤3500 N）。随机选择 577 名年龄≥65 岁、有腹部/盆腔 CT 检查结果的男性进行 BCT 分析。通过电子健康记录收集临床数据，并结合 BCT 中股骨颈 BMD T 评分，使用 FRAX 估计 10 年髋部骨折风险。
BCT 检测的骨质疏松症患病率随年龄增长而增加（65-74 岁年龄组为 13.5%；75-84 岁年龄组为 18.2%；≥85 岁年龄组为 34.3%），估计年龄≥65 岁的男性总体患病率为 18.3%。在骨质疏松症患者中（n=108/577），仅有 38.0%（41/108）有 DXA 检查，18.6%（7/108）接受过骨质疏松症药物治疗。FRAX（≥3%）计算的髋部骨折风险并未完全捕捉到骨强度脆弱的患者。在调整年龄、BMI、种族和 CT 部位的多变量逻辑回归模型中，终末期肾病（优势比 7.4；95%置信区间 2.3-23.9）、COPD（2.2；1.2-4.0）和高剂量吸入皮质类固醇的使用（3.7；1.2-11.8）与 BCT 检测骨质疏松症的几率增加相关。
在男性退伍军人中偶然进行 BCT 可提供另一种途径来识别骨折风险较高的患者。
