CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case-control analysis

Schönenberg, D.; Guggenberger, Roman; Frey, Diana; Pape, Hans-Christian; Simmen, Hans‐Peter; Osterhoff, Georg

doi:10.1007/s00198-017-4307-6

Cited by 23 publications

(18 citation statements)

References 29 publications

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“…The present study used DEXA to evaluate the TBMD as a primary endpoint in rats fed with the KD. DEXA is the gold standard for the diagnosis of osteoporosis, and the T-score is highly correlated with the fracture risk (32). While the present results indicated an obvious decrease in the TBMD in the KD group, the bone loss within certain specific bones required further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Bone loss and biomechanical reduction of appendicular and axial bones under ketogenic diet in rats

Ding

et al. 2019

Exp Ther Med

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A ketogenic diet (KD) is composed of low-carbohydrate, high-fat and adequate levels of protein. It has been used for decades as a method to treat pediatric refractory epilepsy. However, recently, its side effects on the bones have received increasing attention. In order to comprehensively evaluate the effect of KD on the microstructures and mechanical properties of the skeleton, 14 male Sprague-Dawley rats were equally divided into two groups and fed with a KD (ratio of fat to carbohydrate and protein, 3:1) or a standard diet for 12 weeks. Body weight, as well as blood ketone and glucose levels, were monitored during the experiment. Bone morphometric analyses via micro-computerized tomography were performed on cortical and trabecular bone at the middle L4 vertebral body, the proximal humerus and tibia. The compressive stiffness and strength of scanned skeletal areas were calculated using micro-finite element analysis. The KD led to higher ketone levels and lower glucose levels, with reduced body weight and total bone mineral density (TBMD). After 12 weeks, the diet reduced the bone volume fraction, the trabecular number of cancellous bone, cortical thickness, total cross-sectional area inside the periosteal envelope and the bone area of cortical bone in the tibia and humerus, while increasing trabecular separation. However, KD may not affect the L4 vertebral body. The serum calcium or phosphate concentrations in the blood remained unchanged. In addition, bone stiffness and strength were clearly decreased by the KD, and significantly correlated with the BMD and bone area at all scanned sites. In conclusion, KD led to significant bone loss and reduced biomechanical function in appendicular bones, with a lesser impact on axial bones.

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Section: Discussionmentioning

confidence: 99%

Bone loss and biomechanical reduction of appendicular and axial bones under ketogenic diet in rats

Ding

et al. 2019

Exp Ther Med

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“…Similar to the methods used in previous studies, 5,6,16 the ROIs in our study were manually placed in the center of midaxial and midsagittal images of the S1 bodies. The reliability of our measurements was excellent with ICCs comparable to those in the study by Katsuura et al 6 To our knowledge, this is the first study to show the significant correlation between HUs of the S1 body and DXA T-scores, and we found that their Pearson correlation coefficients were comparable to those between HUs of L1-5 and DXA T-scores in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Since lumbar CT is a common examination performed for patients requiring surgery for lumbar degenerative diseases, HUs can be used to evaluate BMD at no extra cost and radiation. There have been a few studies involving the manual measurement of HUs of the S1 body from clinical CT scans, 5,6,16 which support the use of HUs to determine sacral BMD. However, the correlation of HUs of the S1 body with DXA T-scores and the diagnosis of osteoporosis has not been explored.…”

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confidence: 99%

Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases

Zou

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe aim of this study was to evaluate the use of Hounsfield unit (HU) values of the S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases.METHODSThe records of 316 patients of ages ≥ 50 years and requiring surgery for lumbar degenerative diseases were reviewed. The bone mineral density (BMD) of the S1 body and L1 was measured in HU with preoperative lumbar CT. Circular regions of interest (ROIs) were placed on midaxial and midsagittal images of the S1 body. Dual-energy x-ray absorptiometry (DXA) and the criterion of L1 HU ≤ 110 HU were used to diagnose osteoporosis. The area under the receiver operating characteristic curve (AUC) was calculated to assess the use of HUs of the S1 body to diagnose osteoporosis.RESULTSThe interobserver and intraobserver reliability of measuring HU of the S1 body was excellent with intraclass correlation coefficients over 0.8 (p < 0.001). The correlation between HUs of the S1 body and average T-score of L1–4 was significant with Pearson correlation coefficients ≥ 0.60 (p < 0.001). The AUCs for using HUs of the S1 body to diagnose osteoporosis were 0.86 and 0.88 for axial HU and sagittal HU, respectively (p < 0.001). The HU thresholds with balanced sensitivity and specificity for diagnosing osteoporosis were 202 HU for axial HU (sensitivity: 76%; specificity: 76%) and 185 HU for sagittal HU (sensitivity: 80%; specificity: 80%).CONCLUSIONSBoth sagittal and axial HUs of the S1 body are useful tools for assessing BMD and diagnosing osteoporosis. Measuring HUs of the S1 body preoperatively from lumbar CT may help with surgical planning for patients with lumbar degenerative diseases.

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“…Thus, the region of interest in S1 must be carefully selected, in order to avoid areas with extreme high or low density. This could be a reason that the values for S1 are less accurate than published values for L1-L2 [17][18][19]. However, the results for S1 comfortably reached significance, too, allowing us to assume that the methodology presented is suitable for both the lumbar and the sacral spine.…”

Section: Discussionmentioning

confidence: 76%

Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data

et al. 2020

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Purpose Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. Patients and methods Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher − 1, n = 26) was compared with a group with impaired bone density (T-score lower − 1, n = 24). Results A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. Conclusions HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. Level of evidence III.

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CT-based evaluation of volumetric bone density in fragility fractures of the pelvis—a matched case-control analysis

Abstract: level III.

Cited by 23 publications

References 29 publications

Bone loss and biomechanical reduction of appendicular and axial bones under ketogenic diet in rats

Bone loss and biomechanical reduction of appendicular and axial bones under ketogenic diet in rats

Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases

Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data

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