Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
Department of Rehabilitation, City Hospital Bogenhausen, Englschalkinger Straße 77, 81925, Munich, Germany.
Arch Orthop Trauma Surg. 2024 Jan;144(1):179-188. doi: 10.1007/s00402-023-05070-y. Epub 2023 Oct 5.
Dual-energy X-ray absorptiometry (DXA) is considered the gold standard for the diagnosis of osteoporosis and assessment of fracture risk despite proven limitations. Quantitative computed tomography (QCT) is regarded as a sensitive method for diagnosis and follow-up. Pathologic fractures are classified as the main clinical manifestation of osteoporosis. The objective of the study was to compare DXA and QCT to determine their sensitivity and discriminatory power.
Patients aged 50 years and older were included who had DXA of the lumbar spine and femur and additional QCT of the lumbar spine within 365 days. Fractures and bone mineral density (BMD) were retrospectively examined. BMD measurements were analyzed for the detection of osteoporotic fractures. Sensitivity and receiver operating characteristic curve were used for calculations. As an indication for a second radiological examination was given, the results were compared with control groups receiving exclusively DXA or QCT for diagnosis or follow-up.
Overall, BMD measurements of 404 subjects were analyzed. DXA detected 15 (13.2%) patients having pathologic fractures (n = 114) with normal bone density, 66 (57.9%) with osteopenia, and 33 (28.9%) with osteoporosis. QCT categorized no patients having pathologic fractures with healthy bone density, 14 (12.3%) with osteopenia, and 100 (87.7%) with osteoporosis. T-score DXA, trabecular BMD QCT, and cortical BMD QCT correlated weakly. Trabecular BMD QCT and cortical BMD QCT classified osteoporosis with decreased bone mineral density (AUC 0.680; 95% CI 0.618-0.743 and AUC 0.617; 95% CI 0.553-0.682, respectively). T-score DXA could not predict prevalent pathologic fractures. In control groups, each consisting of 50 patients, DXA and QCT were significant classifiers to predict prevalent pathologic fractures.
Our results support that volumetric measurements by QCT in preselected subjects represent a more sensitive method for the diagnosis of osteoporosis and prediction of fractures compared to DXA.
双能 X 射线吸收法（DXA）被认为是诊断骨质疏松症和评估骨折风险的金标准，尽管其存在局限性已被证实。定量计算机断层扫描（QCT）被认为是一种敏感的诊断和随访方法。病理性骨折被归类为骨质疏松症的主要临床表现。本研究的目的是比较 DXA 和 QCT，以确定它们的敏感性和区分能力。
纳入年龄在 50 岁及以上的患者，他们在 365 天内进行了腰椎和股骨的 DXA 以及额外的腰椎 QCT。回顾性检查骨折和骨密度（BMD）。分析 BMD 测量值以检测骨质疏松性骨折。使用灵敏度和接收者操作特征曲线进行计算。作为进行第二次影像学检查的指征，如果结果与仅接受 DXA 或 QCT 进行诊断或随访的对照组进行比较，则将结果进行比较。
总共分析了 404 名患者的 BMD 测量值。DXA 检测到 15 名（13.2%）患有病理性骨折（n=114）且骨密度正常的患者，66 名（57.9%）患有骨量减少的患者，33 名（28.9%）患有骨质疏松症的患者。QCT 将没有患有病理性骨折且骨密度正常的患者分类为 14 名（12.3%）患有骨量减少的患者和 100 名（87.7%）患有骨质疏松症的患者。DXA 的 T 评分、QCT 的小梁骨密度和皮质骨密度与 QCT 相关性较弱。QCT 的小梁骨密度和皮质骨密度将骨质疏松症与骨矿物质密度降低分类（AUC 0.680；95%CI 0.618-0.743 和 AUC 0.617；95%CI 0.553-0.682）。DXA 的 T 评分不能预测普遍存在的病理性骨折。在每组 50 名患者的对照组中，DXA 和 QCT 是预测普遍存在的病理性骨折的重要分类器。
我们的结果支持，在预选患者中，通过 QCT 进行容积测量代表了一种比 DXA 更敏感的骨质疏松症诊断和骨折预测方法。
