Predicting Future Hip Fractures on Routine Abdominal CT Using Opportunistic Osteoporosis Screening Measures: A Matched Case-Control Study
Predicting Future Hip Fractures on Routine Abdominal CT Using Opportunistic Osteoporosis Screening Measures: A Matched Case-Control Study
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DOI：
10.2214/ajr.17.17820
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发表时间：
2017-08-01
影响因子：
5
通讯作者：
Pickhardt, Perry J.
中科院分区：
文献类型：
--
作者：
Lee, Scott J.;Anderson, Paul A.;Pickhardt, Perry J.
OBJECTIVE.髋部骨折是低骨密度的主要后果，这是可以治疗的，但诊断不足。本病例对照研究的目的是确定腰椎骨小梁衰减、椎体压缩性骨折和股骨颈T评分是否与将来髋关节脆性骨折相关，这些评分均来自于各种适应症的腹盆CT扫描。一组204例髋部骨折患者（130例女性和74例男性;平均年龄74.3岁）在骨折发生前（平均间隔24.8个月）接受了腹盆CT检查，并与年龄和性别匹配的对照组（无髋部骨折）进行比较。记录L1骨小梁衰减、2级和3级椎体压缩骨折以及异步定量CT得出的股骨颈T评分。还记录了一个或多个骨折临床风险因素的存在。多变量逻辑回归模型用于确定每个测量值与髋关节炎发生率的相关性。髋部骨折患者与对照组相比，L1骨小梁平均衰减值、一个或多个椎体压缩性骨折的存在以及CT衍生的股骨颈T评分均存在显著差异（p < 0.01）。Logistic回归模型显示，在调整年龄、性别和一个或多个临床危险因素后，所有测量结果与髋部骨折结局显著相关。L1骨小梁衰减和CT衍生的股骨颈T评分在区分病例组和对照组患者方面显示出中等准确性（AUC分别为0.70和0.78）。L1骨小梁衰减、CT衍生的股骨颈T评分以及CT上至少有一处椎体压缩性骨折均与因各种情况接受常规腹盆CT的成年人未来发生髋部脆性骨折相关。
OBJECTIVE. Hip fracture is a major consequence of low bone mineral density, which is treatable but underdiagnosed. The purpose of this case-control study is to determine whether lumbar vertebral trabecular attenuation, vertebral compression fractures, and femoral neck T scores readily derived from abdominopelvic CT scans obtained for various indications are associated with future hip fragility fracture.MATERIALS AND METHODS. A cohort of 204 patients with hip fracture (130 women and 74 men; mean age, 74.3 years) who had undergone abdominopelvic CT before fracture occurred (mean interval, 24.8 months) was compared with an age-and sex-matched control cohort without hip fracture. L1 trabecular attenuation, vertebral compression fractures of grades 2 and 3, and femoral neck T scores derived from asynchronous quantitative CT were recorded. The presence of one or more clinical risk factor for fracture was also recorded. Multivariate logistic regression models were used to determine the association of each measurement with the occurrence of hip fracture.RESULTS. The mean L1 trabecular attenuation value, the presence of one or more vertebral compression fracture, and CT-derived femoral neck T scores were all significantly different in patients with hip fracture versus control subjects (p < 0.01). Logistic regression models showed a significant association of all measurements with hip fracture outcome after adjustments were made for age, sex, and the presence of one or more clinical risk factor. L1 trabecular attenuation and CT-derived femoral neck T scores showed moderate accuracy in differentiating case and control patients (AUC, 0.70 and 0.78, respectively).CONCLUSION. L1 trabecular attenuation, CT-derived femoral neck T scores, and the presence of at least one vertebral compression fracture on CT are all associated with future hip fragility fracture in adults undergoing routine abdominopelvic CT for a variety of conditions.