Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China.
Spine (Phila Pa 1976). 2024 Nov 15;49(22):1570-1576. doi: 10.1097/BRS.0000000000004987. Epub 2024 Mar 13.
Retrospective diagnostic study.
To evaluate the utility of quantitative assessment of bone density using proximal femoral morphological parameters based on full-spine x-rays.
CT and MRI are commonly utilized methods for opportunistic assessment of bone density. However, there is currently a lack of means to quantitatively assess bone density in adult spinal deformity (ASD) patients through radiographs.
Data collection involved medical records of ASD patients treated at our hospital. Patients were categorized into osteoporotic and nonosteoporotic groups based on dual-energy x-ray absorptiometry T-scores. Demographic information, radiographic parameters (canal bone ratio, canal bone ratio (CBR); cortical bone thickness, cortical bone thickness (CBT)), Hounsfield units, and vertebral body quality (VBQ) scores were compared. Pearson correlation analysis was conducted to assess the correlation between CBR, CBT, and T-scores. Multiple linear regression analysis identified independent predictors of bone density T-scores. Receiver operating characteristic curves and area under the curve calculations were performed to investigate the predictive performance for osteoporosis.
A total of 102 patients were included, with the osteoporotic group showing larger CBR and smaller CBT compared with the nonosteoporotic group. Proximal femoral morphological parameters exhibited the strongest correlation with total hip T-scores. Advanced age (β=-0.028, 95% CI=-0.054 to -0.002, P =0.032), low BMI (β=0.07, 95% CI=0.014-0.126, P =0.015), and high CBR (β=-7.772, 95% CI=-10.519 to -5.025, P <0.001) were identified as independent predictors of low bone density. Receiver operating characteristic analysis demonstrated that CBR had a similar osteoporosis screening capability as Hounsfield units, followed by CBT and VBQ scores.
The utilization of CBR from full-spine x-rays is a simple and effective osteoporosis screening indicator for ASD patients, facilitating bone density assessments by spine surgeons for all attending patients.
回顾性诊断研究。
评估基于全脊柱 X 射线的股骨近端形态参数对骨密度的定量评估效用。
CT 和 MRI 是常用的骨密度机会性评估方法。然而，目前尚无通过 X 射线定量评估成人脊柱畸形（ASD）患者骨密度的方法。
本研究的数据来源于我院 ASD 患者的病历资料。根据双能 X 射线吸收法 T 评分，将患者分为骨质疏松组和非骨质疏松组。比较两组患者的人口统计学信息、影像学参数（管腔骨比、管腔骨比（CBR）；皮质骨厚度、皮质骨厚度（CBT））、Hounsfield 单位和椎体质量（VBQ）评分。采用 Pearson 相关分析评估 CBR、CBT 与 T 评分的相关性。采用多元线性回归分析确定骨密度 T 评分的独立预测因素。绘制受试者工作特征曲线和计算曲线下面积，以评估骨质疏松症的预测性能。
共纳入 102 例患者，骨质疏松组的 CBR 较大，CBT 较小。股骨近端形态参数与全髋关节 T 评分相关性最强。高龄（β=-0.028，95%CI=-0.054 至-0.002，P=0.032）、低 BMI（β=0.07，95%CI=0.014-0.126，P=0.015）和高 CBR（β=-7.772，95%CI=-10.519 至-5.025，P<0.001）是骨密度低的独立预测因素。受试者工作特征分析显示，CBR 与 Hounsfield 单位具有相似的骨质疏松症筛查能力，其次是 CBT 和 VBQ 评分。
利用全脊柱 X 射线的 CBR 是 ASD 患者简单有效的骨质疏松症筛查指标，有助于脊柱外科医生对所有就诊患者进行骨密度评估。
