Gleich Johannes, Steiner Elisabeth, Ehrnthaller Christian, Degen Nikolaus, Lampert Christopher, Böcker Wolfgang, Neuerburg Carl, Linhart Christoph
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 80336 Munich, Germany.
J Clin Med. 2025 May 12;14(10):3346. doi: 10.3390/jcm14103346.
: This institutional, register-based analysis aimed to evaluate the feasibility of using CT-based sacral Hounsfield units (HUs) for assessing bone density in pelvic fragility fractures and to explore their potential correlation with DEXA measurements and osteological laboratory diagnostics. : Patients aged > 80 years, admitted between 2003 and 2019 with pelvic ring fractures, were analyzed in this retrospective single-center study. CT scans were evaluated according to the classification of fragility fractures of the pelvis (FFPs), which guided treatment decisions (conservative or surgical). The diagnosis of a fragility fracture was based on both fracture morphology and patient history, including the presence of low-energy trauma. Bone health was assessed using standardized laboratory diagnostics including serum calcium, phosphate, alkaline phosphatase, and 25(OH)-vitamin D, in addition to DEXA scans and CT-derived Hounsfield units. Vitamin D levels and bone density evaluations were analyzed to identify possible correlations among these factors and with fracture patterns. : A total of 456 patients (mean age 87.3 years, 79.6% female) were included. The CT-based FFP classification identified Type II as the most common fracture type (66.7%). Conservative treatment was the predominant approach (84.9%). Serum 25(OH)-vitamin D deficiency was observed in 62.7% of the patients, while osteopenia and osteoporosis were found in 34.3% and 46.5% of cases, respectively. HU values at S1 showed significant correlation with femoral neck T-scores, highlighting the utility of CT scans for bone density assessment. : This study emphasizes the complementary roles of CT-derived HU values and DEXA T-scores in evaluating bone quality and fracture severity in geriatric patients with FFP. While DEXA remains the gold standard, CT imaging offers valuable early insights, supporting the timely initiation of osteoporosis therapy. Given the high prevalence of fragility fractures in this age group, early CT-based screening may facilitate earlier initiation of osteoporosis-specific therapy, including anabolic agents where indicated. Further research is needed to explore the relationships between vitamin D levels, bone density assessments, and fracture types.
这项基于机构登记的分析旨在评估使用基于CT的骶骨亨氏单位（HU）评估骨盆脆性骨折骨密度的可行性，并探讨其与双能X线吸收法（DEXA）测量值及骨学实验室诊断之间的潜在相关性。在这项回顾性单中心研究中，分析了2003年至2019年间收治的年龄大于80岁且伴有骨盆环骨折的患者。根据骨盆脆性骨折（FFP）分类对CT扫描结果进行评估，该分类指导治疗决策（保守治疗或手术治疗）。脆性骨折的诊断基于骨折形态和患者病史，包括低能量创伤的存在情况。除了DEXA扫描和CT衍生的亨氏单位外，还使用包括血清钙、磷酸盐、碱性磷酸酶和25（OH）-维生素D在内的标准化实验室诊断方法评估骨骼健康状况。分析维生素D水平和骨密度评估结果，以确定这些因素之间以及与骨折类型之间的可能相关性。共纳入456例患者（平均年龄87.3岁，79.6%为女性）。基于CT的FFP分类显示II型为最常见的骨折类型（66.7%）。保守治疗是主要的治疗方法（84.9%）。62.7%的患者存在血清25（OH）-维生素D缺乏，而骨量减少和骨质疏松分别在34.3%和46.5%的病例中被发现。S1处的HU值与股骨颈T值显著相关，突出了CT扫描在骨密度评估中的实用性。这项研究强调了CT衍生的HU值和DEXA T值在评估老年FFP患者骨质量和骨折严重程度方面的互补作用。虽然DEXA仍然是金标准，但CT成像提供了有价值的早期见解，支持及时启动骨质疏松症治疗。鉴于该年龄组脆性骨折的高患病率，基于CT的早期筛查可能有助于更早地启动骨质疏松症特异性治疗，包括在有指征时使用合成代谢药物。需要进一步研究来探索维生素D水平、骨密度评估和骨折类型之间的关系。
