Automatic phantom-less QCT predicts hip fracture risk: Bone and muscle parameters comparison

Abstract

Purpose: To evaluate the predictive performance of areal bone mineral density (aBMD), volumetric bone mineral density (vBMD), and intermuscular adipose tissue (IMAT) for hip fracture risk using an automatic phantom-less quantitative computed tomography (PL-QCT) system.

Methods: This retrospective study included 550 patients who underwent hip or pelvic CT: 283 patients with low-energy hip fractures and 267 without fractures. Hip aBMD, vBMD, and IMAT were measured using the automatic PL-QCT system. Propensity score matching was applied to match age, sex, and body mass index between groups. The Mann-Whitney U test was used to compare parameter differences, binary logistic regression to identify independent predictors, and receiver operating characteristic (ROC) curve analysis to evaluate predictive performance.

Results: IMAT was significantly higher in the fracture group, whereas aBMD and vBMD were lower (p < 0.001). Multivariate analysis revealed vBMD as a protective factor (OR < 1, p < 0.05) and IMAT as a risk factor (OR > 1, p < 0.05). IMAT outperformed aBMD and vBMD in predicting fracture risk (AUC: 0.896, 0.768, and 0.815). The combination of IMAT and vBMD achieved the highest predictive value (AUC = 0.927).

Conclusion: Automatic PL-QCT multiparameter measurements, particularly IMAT, outperform aBMD and vBMD alone in predicting hip fracture risk and can better inform orthopedic decision-making.

Keywords: Areal bone mineral density; Hip fracture; Intermuscular adipose tissue; Phantom-less quantitative computed tomography; Volumetric bone mineral density.