Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients

Rebello, Dionne; Anjelly, David; Grand, David; Machan, Jason T.; Beland, Michael D.; Furman, Michael; Shapiro, Jason; Leleiko, Neal S.; Sands, Bruce E.; Mallette, Meaghan; Bright, Renee; Moniz, Heather; Merrick, Marjorie; Shah, Samir A.

doi:10.1007/s00198-018-4444-6

Cited by 19 publications

(6 citation statements)

References 14 publications

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“…In a Chinese population-based study, it was revealed that in men younger than 50 years, the prevalence of osteoporosis was 0.4% when femoral neck was measured and 2.1% when accessed with lumbar spine [ 22 ]. In the present study, the prevalence of osteoporosis in patients newly diagnosed with IBD is similar with that of the same age group in Chinese general population, which was also consistent with previous studies [ 15 , 16 ]. It has been reported that low BMD was more common in patients newly diagnosed with CD rather than UC [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 92%

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Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease

Yin

et al. 2022

Gastroenterology Research and Practice

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Background. Bone loss is common in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the prevalence of metabolic bone disease in patients newly diagnosed with IBD and to identify the risk factors for bone loss over time. Methods. We performed a retrospective, both cross-sectional and longitudinal, study to extract the risk factors of bone loss (including osteopenia and osteoporosis) in patients newly diagnosed with IBD, using dual-energy X-ray absorptiometry (DXA). Results. A total of 639 patients newly diagnosed with IBD that had at least one DXA were included in the cross-sectional study. Osteopenia and osteoporosis were diagnosed in 24.6% and 5.4% of patients, respectively. Age at diagnosis, body mass index, and serum phosphorus were identified as independent factors associated with bone loss at baseline. A total of 380 of the 639 IBD patients (including 212 CD patients and 168 UC patients) with at least a second DXA scan were included in the longitudinal study. 42.6% of the patients presented a worsening of bone loss in the follow-up study. Menopause, albumin, and use of corticosteroids were identified as independent factors associated with worsening of bone loss. Conclusions. Metabolic bone disease is common in IBD patients, and there is a significant increase in prevalence of bone loss over time. Postmenopausal female, malnourished patients, and those requiring corticosteroid treatment are at risk for persistent bone loss. Therefore, BMD measurements and early intervention with supplementation of calcium and vitamin D are recommended in IBD patients with high-risk factors.

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Section: Discussionsupporting

confidence: 92%

“…Of note, with prolonged course of the disease, bone loss aggravated in patients newly diagnosed with IBD [ 15 , 16 ]. The underlying risk factors contributing to the worsening of bone loss are complex and have not yet been fully revealed.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease

Yin

et al. 2022

Gastroenterology Research and Practice

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“…Opportunistic screening for osteoporosis becomes increasingly popular [14, 45]. In contrast to numerous studies of opportunistic screening, where HU values in thoracic or lumbar vertebra were reported [33–35, 46–50], we used asynchronous calibration to obtain lumbar trabecular BMD. Synchronous calibration with an in-scan phantom as in conventional QCT can be replaced by asynchronous calibration as in the opportunistic setting, if scanner stability is maintained [23].…”

Section: Discussionmentioning

confidence: 99%

Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA

et al. 2019

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Objectives To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures. Methods We included 84 patients aged 50 years and older, who had routine CT including the lumbar spine and DXA within a 12-month period (baseline) as well as follow-up imaging after at least 12 months or who sustained an incident vertebral fracture documented earlier. Patients with bone disorders aside from osteoporosis were excluded. Fracture status and trabecular bone mineral density (BMD) were retrospectively evaluated in baseline CT and fracture status was reassessed at follow-up. BMD QCT was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners. Results Sixteen patients had incident vertebral fractures showing lower mean BMD QCT than patients without fracture ( p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD QCT (4.07; 95% CI, 1.98–8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09–5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in T -score was only observed after age and sex adjustment (1.57; 95% CI, 1.04–2.38). The predictability of incident vertebral fractures was good by BMD QCT (AUC = 0.76; 95% CI, 0.64–0.89) and non-significant by T -scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from − 0.55 to − 2.29 HU per year). Conclusions Opportunistic screening of mainly neurosurgical and oncologic patients in CT performed for indications other than densitometry allows for better risk assessment of imminent vertebral fractures than dedicated DXA. Key Points • Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients. • More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA. • Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm 3 ) and osteopenia (≤ 120 mg/cm 3 ) can also be applied scanner independently in calibrated opportunistic QCT.

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“…Das führt zu zusätzlichen für die interne Kalibrierung charakteristischen Richtigkeitsfehlern [36]. Als Alternative zur internen Kalibrierung wurde vorgeschlagen, unkalibrierte HounsfieldEinheiten direkt zur Abschätzung des Frakturrisikos zu benutzen [37][38][39][40]. HU Werte sind aber CT Scanner spezifisch und abhängig von der Röhrenspannung, d. h. die Berechnung des Frakturrisikos ist Scanner und kV abhängig, eine Standardisierung scheint fast unmöglich.…”

Section: Opportunistic Screeningunclassified

Messtechnische Verfahren im Kontext der DVO Leitlinie – neue Entwicklungen

Engelke¹,

Müller

Bühring

et al. 2023

Osteologie

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ZusammenfassungDie Osteodensitometrie, die Bestimmung von Knochendichte und biochemischer Knochenumbauparameter sind ein integraler Bestandteil der DVO Leitlinie. Dieser Beitrag gibt einen Überblick über neue Studien und neue technische Entwicklungen soweit sie insbesondere im Kontext der Leitlinie, also für Diagnose, Bestimmung des Frakturrisikos und Verlaufskontrolle relevant sind. Dabei stehen zunächst die Verfahren im Vordergrund, die unmittelbar zur Anpassung von Empfehlungen geführt haben. Andere Techniken wie das sogenannte „opportunistic screening“ von Routine CT Aufnahmen haben zwar noch keinen Eingang in die Leitlinie gefunden, allerdings scheint aufgrund ihres Potentials, die Identifikation von Patienten mit hohem Frakturrisiko wesentlich zu verbessern, ein Überblick auch über diese Methoden im Rahmen dieses Beitrages gerechtfertigt.

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Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients

Abstract: Using CT scans obtained for other indications, we found low rates of osteopenia and osteoporosis that may otherwise have gone undiagnosed. Refinement of opportunistic screening may have advantages in terms of cost-savings and earlier detection of bone loss.

Cited by 19 publications

References 14 publications

Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease

Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease

Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA

Messtechnische Verfahren im Kontext der DVO Leitlinie – neue Entwicklungen

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