Cheneymann Andia, Therkildsen Josephine, Rasmussen Laust Dupont, Thygesen Jesper, Isaksen Christin, Hauge Ellen-Margrethe, Winther Simon, Böttcher Morten
Department of Cardiology, University Clinic for Cardiovascular Research, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark.
Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark.
Calcif Tissue Int. 2024 Oct;115(4):421-431. doi: 10.1007/s00223-024-01268-3. Epub 2024 Aug 16.
Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm), low (80-120 mg/cm), and normal BMD (> 120 mg/cm) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31-74] years, 51% women) had a lumbar BMD of 121.6 mg/cm (95% CI 115.9-127.3) and a thoracic BMD of 137.0 mg/cm (95% CI: 131.5-142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis.
骨质疏松症的诊断不足，而通过使用定量计算机断层扫描（QCT）测量骨密度（BMD）是可检测到的。此前曾建议使用腰椎QCT对低骨密度进行机会性筛查。然而，胸部QCT也有潜力为低胸段骨密度制定上下界值，这与当前腰椎骨密度的界值相对应。在因胸痛转诊的参与者中，使用非增强腰椎和心脏CT扫描测量腰椎和胸部骨密度。使用极低（<80mg/cm）、低（80 - 120mg/cm）和正常骨密度（>120mg/cm）的腰椎骨密度界值来评估相应的胸部骨密度值。通过线性回归确定了新的诊断性胸段骨密度界值。177名参与者（平均年龄61岁[范围31 - 74岁]，51%为女性）的腰椎骨密度为121.6mg/cm（95%CI 115.9 - 127.3），胸段骨密度为137.0mg/cm（95%CI：131.5 - 142.5），p < 0.001。腰椎骨密度分类显示，各骨密度类别分别为14%、35%和45%。当应用于胸段骨密度测量时，25%的参与者被重新分类到较低组。线性回归预测胸段骨密度 = 0.85×腰椎骨密度 + 33.5，得出调整后的胸段骨密度界值为<102和>136mg/cm。发现腰椎和胸段区域的骨密度存在显著差异，但线性关系使得能够为胸椎低骨密度制定胸段上下界值。由于胸部CT扫描很常见，这些发现将加强利用CT图像进行骨质疏松症的机会性检测。
