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. 2023 Oct 1;36(8):E369-E374.
doi: 10.1097/BSD.0000000000001466. Epub 2023 Jun 5.

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis: A Comparison of Dual-energy X-ray Absorptiometry and Lumbar Computed Tomography Hounsfield Units

Stephan Aynaszyan  1 , Luis G Devia  1 , Matthew W Parry  1 , Siddharth Badve  2 , Edward M DelSole  1   2
Affiliations

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis: A Comparison of Dual-energy X-ray Absorptiometry and Lumbar Computed Tomography Hounsfield Units

Stephan Aynaszyan et al. Clin Spine Surg. .

Abstract

Study design: This was a retrospective chart review.

Objective: This study aims to identify the prevalence of osteoporosis (OP) by lumbar computed tomography (CT) Hounsfield units (HUs) in patients who have normal or osteopenic bone determined by dual-energy x-ray absorptiometry (DEXA).

Summary of background data: OP is a critical issue in the postmenopausal and aging population. Bone mineral density assessment by DEXA has been described as insensitive for diagnosing OP in the lumbar spine. Improving the detection of OP can bring more patients to treatment and reduce the risks associated with low bone mineral density.

Patients and methods: We retrospectively reviewed all patients with DEXA scans and noncontrast CTs of the lumbar spine over a 15-year period. Patients were diagnosed as non-OP if they had a normal DEXA T -score (≥ -1) or osteopenic DEXA T -score (between -1.1 and -2.4). Patients in this cohort were considered osteoporotic by CT if L1-HU ≤110. Demographics and lumbar HUs were compared between these stratified groups.

Results: A total of 74 patients were included for analysis. All patients were demographically, similar, and the average patient age was 70 years. The prevalence of OP determined by CT L1-HU ≤110 was 46% (normal DEXA: 9%, osteopenic DEXA: 63%). A significant number of males in our study were considered osteoporotic by L1-HU ≤110 (74%, P = 0.03). All individual axial and sagittal lumbar HU measurements including L1-L5 average lumbar HUs were statistically significant among non-OP and OP groups except for the lower lumbar levels ( P > 0.05 for L4 axial HUs, and L4-L5 sagittal HUs).

Conclusions: The prevalence of OP in patients with normal or osteopenic T -scores is high. Among those with osteopenia by DEXA, more than 50% may lack appropriate medical treatment. The DEXA scan may be particularly insensitive to male bone quality making the CT HU the diagnostic method of choice for detecting OP.

Level of evidence: Level III.

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Conflict of interest statement

E.M.D. has consulted or has done independent contracting for Depuy Synthes, Cerapedics, Medacta International, Guidepoint Global, and Orthobullets. He serves on the political engagement council of the North American Spine Society. He is on the editorial board of Clinical Spine Surgery . The remaining authors declare no conflict of interest.

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References

    1. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief. 2021;405:1–8.
    1. Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine. 1994;19:2415–2420.
    1. Soshi S, Shi R, Kondo H, et al. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar. Spine. 1991;16:1335–1341.
    1. Kim DK, Kim JY, Kim DY, et al. Risk factors of proximal junctional kyphosis after multilevel fusion surgery: More than 2 years follow-up data. J Korean Neurosurg Soc. 2017;60:174–180.
    1. Maier GS, Kolbow K, Lazovic D, et al. The importance of bone mineral density in hip arthroplasty: results of a survey asking orthopaedic surgeons about their opinions and attitudes concerning osteoporosis and hip arthroplasty. Adv Orthop. 2016;2016:1–5.