Opportunistic Osteoporosis Screening-Gleaning Additional Information from Diagnostic Wrist CT Scans
Opportunistic Osteoporosis Screening-Gleaning Additional Information from Diagnostic Wrist CT Scans
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DOI：
10.2106/jbjs.n.01230
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发表时间：
2015-07-01
影响因子：
5.3
通讯作者：
Weiland, Andrew J.
中科院分区：
文献类型：
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作者：
Schreiber, Joseph J.;Gausden, Elizabeth B.;Weiland, Andrew J.
背景：虽然骨质疏松症的筛查和治疗可以预防后续骨折，但桡骨远端骨折后此类干预的发生率很低。鉴别代谢性骨病的一种潜在方法是通过诊断性计算机断层扫描（CT）的Hounsfield单位（HU）测量。我们假设桡骨远端HU值可用于评估局部骨质量，并可预测桡骨远端骨折风险，从而识别需要进一步治疗的患者。方法：根据桡骨远端松质部分、尺头和头的HU值测量100例患者的骨密度（BMD）。我们将25名男性和25名女性的急性桡骨远端骨折的CT记录的HU值与年龄和性别匹配的对照患者进行比较，这些患者进行了其他适应症的CT扫描。结果：在对照组中，HU值随年龄的增加而降低。当以性别为基础进行评估时，与非骨折对照患者相比，桡骨远端骨折的男性和女性患者的区域骨密度均显著降低。女性桡骨远端HU值为218，男性为246，敏感性和特异性最佳；低于这个阈值与桡骨远端骨折的风险增加有关。结论：使用现代软件程序可以从任何诊断性CT扫描中获得HU测量值，并且可以由医生在办公室环境中以最小的努力获得，并且不需要额外的费用或对患者的辐射暴露。无论影像学指征如何，我们建议HU值低于确定阈值的患者应考虑进一步的代谢性骨病检查，如额外的影像学检查、实验室评估、骨质疏松症治疗的开始或适当的转诊。
Background: Although screening for and treating osteoporosis can prevent subsequent fractures, the rates of such interventions are low following a distal radial fracture. One potential method for identifying metabolic bone disease is via Hounsfield unit (HU) measurements from diagnostic computed tomography (CT) scans. We hypothesized that HU values of the distal aspect of the radius could be used to assess local bone quality and would be predictive of distal radial fracture risk, thereby allowing the identification of patients in need of further management.Methods: Measurements of bone mineral density (BMD) were made for 100 patients on the basis of HU values of cancellous portions of the distal aspect of the radius, the ulnar head, and the capitate. The HU values in twenty-five male and twenty-five female patients with an acute distal radial fracture documented on CT were compared with those of age and sex-matched control patients who had a CT scan obtained for other indications.Results: Among the control patients, HU values decreased as age increased. When assessed on the basis of sex, both male and female patients with a distal radial fracture had significantly lower regional BMD compared with nonfracture control patients. A distal radial HU value of 218 for females and 246 for males optimized sensitivity and specificity; values below this threshold were associated with an increased risk of distal radial fracture.Conclusions: HU measurements can be obtained from any diagnostic CT scan using modern software programs and can be obtained by physicians in the office setting with minimal effort and at no additional cost or radiation exposure to the patient. Regardless of imaging indications, we suggest that patients with HU values below the identified thresholds be considered for further metabolic bone disease work-up, such as additional imaging, laboratory assessments, the initiation of osteoporosis treatment, or appropriate referral.