Based on CT at the third lumbar spine level, the skeletal muscle index and psoas muscle index can predict osteoporosis

Abstract

Background With the increasing number of studies on osteoporosis and muscle adipose tissue, existing studies have shown that skeletal muscle tissue and adipose tissue are closely related to osteoporosis by dual-energy x-ray absorptiometry (DXA) measurement. However, few studies have explored whether the skeletal muscle and adipose tissue index measured at the lumbar spine 3 (L3) level are closely related to bone mineral density (BMD) and can even predict osteoporosis. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are closely related to BMD. Methods A total of 180 participants were enrolled in this study to obtain skeletal muscle index (SMI), psoas muscle index (PMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at L3 levels and divide them into osteoporotic and normal groups based on the T-score of DXA. Spearman rank correlation was used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and BMD. Similarly, spearman rank correlation was also used to analyze the correlation between SMI, PMI, SFI, VFI, VSR, and the fracture risk assessment tool (FRAX). Receiver operating characteristic (ROC) was used to analyze the efficacy of SMI, PMI, SFI, VFI, and VSR in predicting osteoporosis. Results BMD of L1-4 was closely correlated with SMI, PMI, VFI and VSR (r = 0.199 p = 0.008, r = 0.422 p < 0.001, r = 0.253 p = 0.001, r = 0.310 p < 0.001). BMD of the femoral neck was only correlated with PMI and SFI (r = 0.268 p < 0.001, r = − 0.164 p-0.028). FRAX (major osteoporotic fracture) was only closely related to PMI (r = − 0.397 p < 0.001). FRAX (hip fracture) was closely related to SMI and PMI (r = − 0.183 p = 0.014, r = − 0.353 p < 0.001). Besides, FRAX (major osteoporotic fracture and hip fracture) did not correlate with VFI, SFI, and VSR. SMI and PMI were statistically significant, with the area under the curve (AUC) of 0.400 (95% confidence interval 0.312-0.488 p = 0.024) and 0.327 (95% confidence interval 0.244-0.410 p < 0.001), respectively. VFI, SFI, and VSR were not statistically significant in predicting osteoporosis. Conclusions This study demonstrated that L3-based muscle index could assist clinicians in the diagnosis of osteoporosis to a certain extent, and PMI is superior to SMI in the diagnosis of osteoporosis. In addition, VFI, SFI, and VSR do not help clinicians to diagnose osteoporosis well.

Skeletal muscle index based on CT at the 12th thoracic spine level can predict osteoporosis and fracture risk: a propensity score-matched cohort study

“…Skeletal muscle cross-sectional area at the middle level of the T12 vertebral body was calculated using Image J (NIH Image J version 1.52c) software ( Figure 1 ). Relevant studies ( 20 ) have shown that the skeletal muscle threshold ranges from −29HU to 150HU, and the skeletal muscle area was measured within this threshold range in this study. SMI was derived by dividing the calculated area value by the square of the patient’s height (m 2 ).…”

Vertebral HU value and the pectoral muscle index based on chest CT can be used to opportunistically screen for osteoporosis

“…We speculate that this may have been influenced by muscle and sample size. The study by Huang et al [42] on the psoas major index at the L3 level included a total of 180 patients, which is a much smaller sample size than that in our study.…”

Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies

“…Huang et al ( 45 ) found a close correlation between psoas muscle index and BMD in the femoral neck and lumbar spine; a strong association was also found with the FRAX. This study group demonstrated that L3-based muscle index could be a useful tool in the diagnosis of OP, and that psoas muscle index is a better indicator of OP compared to skeletal muscle index.…”