Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis

Abstract

The surgeon general of the USA defines osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." Measuring bone strength, Biomechanical Computed Tomography analysis (BCT), namely, finite element analysis of a patient's clinical-resolution computed tomography (CT) scan, is now available in the USA as a Medicare screening benefit for osteoporosis diagnostic testing. Helping to address under-diagnosis of osteoporosis, BCT can be applied "opportunistically" to most existing CT scans that include the spine or hip regions and were previously obtained for an unrelated medical indication. For the BCT test, no modifications are required to standard clinical CT imaging protocols. The analysis provides measurements of bone strength as well as a dual-energy X-ray absorptiometry (DXA)equivalent bone mineral density (BMD) T-score at the hip and a volumetric BMD of trabecular bone at the spine. Based on both the bone strength and BMD measurements, a physician can identify osteoporosis and assess fracture risk (high, increased, not increased), without needing confirmation by DXA. To help introduce BCT to clinicians and health care professionals, we describe in this review the currently available clinical implementation of the test (VirtuOst), its application for managing patients, and the underlying supporting evidence; we also discuss its main limitations and how its results can be interpreted clinically. Together, this body of evidence supports BCT as an accurate and convenient diagnostic test for osteoporosis in both sexes, particularly when used opportunistically for patients already with CT.

Comparison of Vertebral and Femoral Strength Between White and Asian Adults Using Finite Element Analysis of Computed Tomography Scans

“…(5) Biomechanical computed tomography analysis (BCT), a generic name for finite element analysis of clinical-resolution CT scans, has been proposed as one possible noninvasive approach to improve the accessibility and performance of fracture risk assessment. (6)(7)(8) Bone strength estimated by BCT has shown better performance in predicting femoral failure load than DXA aBMD, or quantitative computed tomography (QCT) models in human cadaver studies. (9) Fragile bone strength (spine: women ≤4500 N, men ≤6500 N; hip: women ≤3000 N, men ≤3500 N) measured using routine abdominal or pelvic CT scans has shown comparable performance to DXA for predicting spine or hip fractures with higher sensitivity.…”

Computed tomography-based opportunistic osteoporosis assessment: a comparison of two software applications for lumbar vertebral volumetric bone mineral density measurements

“…This indicates that the IP analysis is not suitable for analyzing scans other than those obtained at 120 kVp. Opportunistic vBMD measurement with a CT-based method, both in MECT and DECT mode, is useful, with the potential to contribute to an earlier discovery of osteoporosis without increased radiation exposure (3,4,12,(14)(15)(16)(17)(18). However, the BMD values determined by different software programs in the same patients across different machines should be comparable.…”

“…Various computed tomography (CT)-based methods can be used to potentially improve bone quality assessment and make the diagnosis process in FLSs more effective (4,9,10). FLSs could perform opportunistic volumetric BMD (vBMD) assessment using CT scans conducted at the time of fracture occurrence (i.e., when detecting a vertebral fracture using abdominal or thoracic CT scans) as well as identifying high-risk individuals during opportunistic screening when investigating patients for other diagnoses (3,(10)(11)(12)(13)(14)(15)(16)(17)(18). It is important that these CT-based methods are shown to be reliable and stable across various software programs, CT machines and scan protocols (i.e., not only protocols specific to skeletal imaging).…”

Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique

“…Patients with painful OVCFs, treated by PVP at our hospital between July 2018 and December 2019, were included in our study. Inclusion criteria for the study were as follows: (1) age >60 years; (2) osteoporosis diagnosed by measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA), with BMD T-score ≤ − 2.5 [17]; 3 A total of 155 patients (27 males, 128 females) with a mean age of 77.2 ± 8.9 years (range, 60-97 years) were enrolled in the study. We divided them into two groups according to the puncture approach.…”