Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift

Abstract

Purpose of Review-Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part ofroutine patient care to "opportunistically" screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis. Recent Findings-Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures. Summary-The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.

Evaluation and Correlation between craniofacial bone densities and C1 and C2 cervical vertebrae using multislice computed tomography.

“…[9] Positive correlations has been observed between HU from vertebrae and skeletal BMD values. [10] HU is a coefficient that measure the absorption of x-rays from CT, the HU units ranges from 1000 to 0, values closer to 1000 HU means radiodensity of water and values next to 0 HU means a density close to the air [11][12][13].…”

“…Head CT examination is often requested by dentists and physicians, allowing the opportunistic screening for osteoporosis and early diagnosis of the disease, which may lead to a higher chance of a better prognosis (11). Therefore, the objective of this study is to evaluate the use of maxillary or mandibular CT as a screening tool for osteoporosis, verifying the correlation between the BMD of the maxilla or mandible structures and cervical vertebrae, using HU values.…”

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

“…Osteoporosis decreases bone strength and density, so it is reasonable to examine bone density as part of preoperative planning. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA) [1,2]. Many patients undergo computed tomography (CT) of the spine before surgery.…”

Finite Element Analysis-Based Vertebral Bone Strength Prediction Using MDCT Data: How Low Can We Go?

“…Also, the complex anatomical structure of bone tissue emphasizes the importance of considering the critical interaction between different structural elements of the bone while assessing bone fracture risk (10). Quantitative computed tomography (QCT) imaging has been used in place of DXA to measure volumetric BMD from attenuation values, calibrated using a phantom, in assessing bone quality and condition (11)(12)(13)(14).…”