Opportunistic QCT Bone Mineral Density Measurements Predicting Osteoporotic Fractures: A Use Case in a Prospective Clinical Cohort

Front Endocrinol (Lausanne). 2020 Nov 9:11:586352. doi: 10.3389/fendo.2020.586352. eCollection 2020.


Purpose: To assess whether volumetric vertebral bone mineral density (BMD) measured with opportunistic quantitative computed tomography (QCT) (i.e., CT acquired for other reasons) can predict osteoporotic fracture occurrence in a prospective clinical cohort and how this performs in comparison to dual-energy X-ray absorptiometry (DXA) measurements.

Methods: In the database of our fracture liaison service, 58 patients (73 ± 11 years, 72% women) were identified that had at least one prevalent low-energy fracture and had undergone CT of the spine. BMD was determined by converting HU using scanner-specific conversion equations. Baseline DXA was available for 31 patients. During a 3-year follow-up, new fractures were diagnosed either by (i) recent in-house imaging or (ii) clinical follow-up with validated external reports. Associations were assessed using logistic regression models, and cut-off values were determined with ROC/Youden analyses.

Results: Within 3 years, 20 of 58 patients presented new low-energy fractures (34%). Mean QCT BMD of patients with fractures was significantly lower (56 ± 20 vs. 91 ± 38 mg/cm3; p = 0.003) and age was higher (77 ± 10 vs. 71 ± 11 years; p = 0.037). QCT BMD was significantly associated with the occurrence of new fractures, and the OR for developing a new fracture during follow-up was 1.034 (95% CI, 1.010-1.058, p = 0.005), suggesting 3% higher odds for every unit of BMD decrease (1 mg/cm3). Age and sex showed no association. For the differentiation between patients with and without new fractures, ROC showed an AUC of 0.76 and a Youden's Index of J = 0.48, suggesting an optimal cut-off value of 82 mg/cm3. DXA T-scores showed no significant association with fracture occurrence in analogous regression models.

Conclusion: In this use case, opportunistic BMD measurements attained through QCT predicted fractures during a 3-year follow-up. This suggests that opportunistic measurements are useful to reduce the diagnostic gap and evaluate the fracture risk in osteoporotic patients.

Keywords: DXA; QCT; bone mineral density; fracture liaison service; fracture prediction; osteoporosis; osteoporotic fracture.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods*
  • Aged
  • Aged, 80 and over
  • Bone Density*
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Lumbar Vertebrae / injuries
  • Male
  • Middle Aged
  • Osteoporotic Fractures / diagnostic imaging*
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Spinal Fractures / diagnostic imaging*
  • Thoracic Vertebrae / injuries
  • Tomography, X-Ray Computed / methods*