Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States.
Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, United States.
Orthop Traumatol Surg Res. 2024 Dec;110(8):103935. doi: 10.1016/j.otsr.2024.103935. Epub 2024 Aug 17.
Underdiagnosis or undertreatment of osteoporosis consequently impacts individual morbidity and mortality, as well as on healthcare systems and communities as a whole. Dual-energy x-ray absorptiometry (DXA) is the gold standard method for identifying osteoporosis, however, opportunistic CT screening is capable of precisely estimating bone mineral density (BMD) in abdominopelvic imaging with no additional cost, radiation exposure or inconvenience to patients. This study uses opportunistic CT screening to determine the prevalence of osteoporosis and anatomic distribution patterns in patients presenting with lower extremity fractures at our institution.
Trauma patients with low bone mineral density (BMD) are more likely to present with peri-articular versus shaft fractures.
We conducted a retrospective review of 721 patients presenting as trauma activations to the emergency department (ED) of a Level 1 Trauma Center with lower extremity fractures. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the ED. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone mineral density. Values of ≤100 HU were consistent with osteoporosis, whereas 101-150 HU were consistent with osteopenia.
The final cohort included 416 patients, with mean age of 49 ± 21 years. Average bone density was 203.9 ± 73.4 HU. 15.9% of patients were diagnosed as osteopenic and 9.9% as osteoporotic. 64.2% of fractures were peri-articular, 25.7% were shaft, and 10.1% were a combination. Peri-articular fractures were significantly more likely to have lower average BMD than shaft fractures (189 ± 74.7 HU vs. 230.6 ± 66.1 HU, p < 0.001).
Our study demonstrates a significant relationship between low bone mineral density and lower extremity fracture pattern, however, likely influenced by other factors such as sex. Opportunistic CT screening for osteoporosis in trauma settings provides ample opportunity for early detection of low BMD and implementation of highly effective lifestyle modification and pharmacotherapy intervention. Reduction in the overall incidence of peri-articular fracture with widespread adoption of opportunistic CT screening may lessen the morbidity, mortality, and total cost currently afflicting patients, healthcare systems, and communities.
III, therapeutic.
骨质疏松症的诊断不足或治疗不足会对个人的发病率和死亡率产生影响，同时也会对整个医疗保健系统和社区产生影响。双能 X 射线吸收法（DXA）是识别骨质疏松症的金标准方法，但是，机会性 CT 筛查能够在不增加额外成本、辐射暴露或不便患者的情况下，精确估计腹盆成像中的骨矿物质密度（BMD）。本研究使用机会性 CT 筛查来确定我们机构中下肢骨折患者的骨质疏松症患病率和解剖分布模式。
骨矿物质密度（BMD）低的创伤患者更有可能出现关节周围骨折而不是骨干骨折。
我们对一家一级创伤中心急诊部（ED）因创伤就诊的 721 名患者进行了回顾性研究，这些患者有下肢骨折。如果患者年龄在 18 岁以下或在到达 ED 时缺乏 CT 扫描，则将其排除在外。在 CT 扫描的 L1 椎体水平测量亨氏单位（HU）以确定骨矿物质密度。HU 值≤100 与骨质疏松症一致，而 101-150 HU 与骨量减少一致。
最终队列包括 416 名患者，平均年龄为 49±21 岁。平均骨密度为 203.9±73.4 HU。15.9%的患者被诊断为骨量减少，9.9%的患者被诊断为骨质疏松症。64.2%的骨折为关节周围，25.7%为骨干，10.1%为两者混合。关节周围骨折的平均 BMD 明显低于骨干骨折（189±74.7 HU 比 230.6±66.1 HU，p<0.001）。
我们的研究表明，骨矿物质密度低与下肢骨折类型之间存在显著关系，但可能受到性别等其他因素的影响。在创伤环境中，机会性 CT 筛查骨质疏松症为早期发现低 BMD 并实施高效的生活方式改变和药物治疗干预提供了充分的机会。广泛采用机会性 CT 筛查可能会降低关节周围骨折的总体发生率，从而减轻目前影响患者、医疗保健系统和社区的发病率、死亡率和总成本。
III，治疗性。
