Department of Spine Surgery, Geisinger Commonwealth School of Medicine.
Department of Spine Surgery, Geisinger Musculoskeletal Institute, Scranton, PA.
Clin Spine Surg. 2023 Oct 1;36(8):E369-E374. doi: 10.1097/BSD.0000000000001466. Epub 2023 Jun 5.
This was a retrospective chart review.
This study aims to identify the prevalence of osteoporosis (OP) by lumbar computed tomography (CT) Hounsfield units (HUs) in patients who have normal or osteopenic bone determined by dual-energy x-ray absorptiometry (DEXA).
OP is a critical issue in the postmenopausal and aging population. Bone mineral density assessment by DEXA has been described as insensitive for diagnosing OP in the lumbar spine. Improving the detection of OP can bring more patients to treatment and reduce the risks associated with low bone mineral density.
We retrospectively reviewed all patients with DEXA scans and noncontrast CTs of the lumbar spine over a 15-year period. Patients were diagnosed as non-OP if they had a normal DEXA T -score (≥ -1) or osteopenic DEXA T -score (between -1.1 and -2.4). Patients in this cohort were considered osteoporotic by CT if L1-HU ≤110. Demographics and lumbar HUs were compared between these stratified groups.
A total of 74 patients were included for analysis. All patients were demographically, similar, and the average patient age was 70 years. The prevalence of OP determined by CT L1-HU ≤110 was 46% (normal DEXA: 9%, osteopenic DEXA: 63%). A significant number of males in our study were considered osteoporotic by L1-HU ≤110 (74%, P = 0.03). All individual axial and sagittal lumbar HU measurements including L1-L5 average lumbar HUs were statistically significant among non-OP and OP groups except for the lower lumbar levels ( P > 0.05 for L4 axial HUs, and L4-L5 sagittal HUs).
The prevalence of OP in patients with normal or osteopenic T -scores is high. Among those with osteopenia by DEXA, more than 50% may lack appropriate medical treatment. The DEXA scan may be particularly insensitive to male bone quality making the CT HU the diagnostic method of choice for detecting OP.
Level III.
这是一项回顾性图表回顾研究。
本研究旨在通过腰椎计算机断层扫描（CT）的 Hounsfield 单位（HU）确定双能 X 射线吸收法（DEXA）测定正常或骨质疏松骨的患者中骨质疏松症（OP）的患病率。
OP 是绝经后和老年人群中的一个关键问题。DEXA 进行的骨矿物质密度评估已被描述为对腰椎 OP 的诊断不敏感。提高 OP 的检出率可以使更多的患者接受治疗，并降低与低骨矿物质密度相关的风险。
我们对 15 年来所有接受 DEXA 扫描和腰椎非对比 CT 的患者进行了回顾性分析。如果患者的 DEXA T 评分正常（≥-1）或骨质疏松 DEXA T 评分（在-1.1 至-2.4 之间），则将其诊断为非 OP。如果 L1-HU≤110，则该队列中的患者将通过 CT 诊断为骨质疏松症。对这些分层组的人口统计学和腰椎 HU 进行了比较。
共有 74 例患者纳入分析。所有患者在人口统计学上相似，平均患者年龄为 70 岁。通过 CT L1-HU≤110 确定的 OP 患病率为 46%（正常 DEXA：9%，骨质疏松 DEXA：63%）。我们的研究中，相当数量的男性通过 L1-HU≤110 被认为患有骨质疏松症（74%，P=0.03）。除了较低的腰椎水平（P>0.05 用于 L4 轴向 HU 和 L4-L5 矢状 HU）之外，非 OP 和 OP 组之间所有单个轴向和矢状腰椎 HU 测量值，包括 L1-L5 平均腰椎 HU，均具有统计学意义。
正常或骨质疏松 T 评分患者中 OP 的患病率较高。在 DEXA 检查为骨质疏松症的患者中，超过 50%的患者可能缺乏适当的治疗。DEXA 扫描对男性骨骼质量可能特别不敏感，因此 CT HU 是检测 OP 的首选诊断方法。
三级。
