Correlation between Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry and Hounsfield Units Measured by Diagnostic CT in Lumbar Spine

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Abstract

Objective

Use of quantitative computed tomography (CT) to evaluate bone mineral density was suggested in the 1970s. Despite its reliability and accuracy, technical shortcomings restricted its usage, and dual-energy X-ray absorptiometry (DXA) became the gold standard evaluation method. Advances in CT technology have reduced its previous limitations, and CT evaluation of bone quality may now be applicable in clinical practice. The aim of this study was to determine if the Hounsfield unit (HU) values obtained from CT correlate with patient age and bone mineral density.

Methods

A total of 128 female patients who underwent lumbar CT for back pain were enrolled in the study. Their mean age was 66.4 years. Among them, 70 patients also underwent DXA. The patients were stratified by decade of life, forming five age groups. Lumbar vertebrae L1-4 were analyzed. The HU value of each vertebra was determined by averaging three measurements of the vertebra's trabecular portion, as shown in consecutive axial CT images. The HU values were compared between age groups, and correlations of HU value with bone mineral density and T-scores were determined.

Results

The HU values consistently decreased with increasing age with significant differences between age groups ( p<0.001). There were significant positive correlations ( p<0.001) of HU value with bone mineral density and T-score.

Conclusion

The trabecular area HU value consistently decreases with age. Based on the strong positive correlation between HU value and bone mineral density, CT-based HU values might be useful in detecting bone mineral diseases, such as osteoporosis.

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Most cited references 13

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Prevention and management of osteoporosis.

(2002)

Bone is hard tissue that is in a constant state of flux, being built up by bone-forming cells called osteoblasts while also being broken down or resorbed by cells known as osteoclasts. During childhood and adolescence, bone formation is dominant; bone length and girth increase with age, ending at early adulthood when peak bone mass is attained. Males generally exhibit a longer growth period, resulting in bones of greater size and overall strength. In males after the age of 20, bone resorbtion becomes predominant, and bone mineral content declines about 4% per decade. Females tend to maintain peak mineral content until menopause, after which time it declines about 15% per decade. Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine, and wrist. Osteoporosis occurs primarily as a result of normal ageing, but can arise as a result of impaired development of peak bone mass (e.g. due to delayed puberty or undernutrition) or excessive bone loss during adulthood (e.g. due to estrogen deficiency in women, undernutrition, or corticosteroid use). Osteoporosis-induced fractures cause a great burden to society. Hip fractures are the most serious, as they nearly always result in hospitalization, are fatal about 20% of the time, and produce permanent disability about half the time. Fracture rates increase rapidly with age and the lifetime risk of fracture in 50 year-old women is about 40%, similar to that for coronary heart disease. In 1990, there were 1.7 million hip fractures alone worldwide; with changes in population demographics, this figure is expected to rise to 6 million by 2050. To help describe the nature and consequences of osteoporosis, as well as strategies for its prevention and management, a WHO Scientific Group meeting of international experts was held in Geneva, which resulted in this technical report. This monograph describes in detail normal bone development and the causes and risk factors for developing osteoporosis. The burden of osteoporosis is characterized in terms of mortality, morbidity, and economic costs. Methods for its prevention and treatment are discussed in detail for both pharmacological and non-pharmacological approaches. For each approach, the strength of the scientific evidence is presented. The report also provides cost-analysis information for potential interventions, and discusses important aspects of developing national policies to deal with osteoporosis. Recommendations are made to the general population, care providers, health administrators, and researchers. Lastly, national organizations and support groups are listed by country.

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Quantitative computed tomography.

Judith E Adams (2009)

Quantitative computed tomography (QCT) was introduced in the mid 1970s. The technique is most commonly applied to 2D slices in the lumbar spine to measure trabecular bone mineral density (BMD; mg/cm(3)). Although not as widely utilized as dual-energy X-ray absortiometry (DXA) QCT has some advantages when studying the skeleton (separate measures of cortical and trabecular BMD; measurement of volumetric, as opposed to 'areal' DXA-BMDa, so not size dependent; geometric and structural parameters obtained which contribute to bone strength). A limitation is that the World Health Organisation (WHO) definition of osteoporosis in terms of bone densitometry (T score -2.5 or below using DXA) is not applicable. QCT can be performed on conventional body CT scanners, or at peripheral sites (radius, tibia) using smaller, less expensive dedicated peripheral CT scanners (pQCT). Although the ionising radiation dose of spinal QCT is higher than for DXA, the dose compares favorably with those of other radiographic procedures (spinal radiographs) performed in patients suspected of having osteoporosis. The radiation dose from peripheral QCT scanners is negligible. Technical developments in CT (spiral multi-detector CT; improved spatial resolution) allow rapid acquisition of 3D volume images which enable QCT to be applied to the clinically important site of the proximal femur, more sophisticated analysis of cortical and trabecular bone, the imaging of trabecular structure and the application of finite element analysis (FEA). Such research studies contribute importantly to the understanding of bone growth and development, the effect of disease and treatment on the skeleton and the biomechanics of bone strength and fracture.

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Pre-existing fractures and bone mass predict vertebral fracture incidence in women.

Irving R. Epstein, J. Davis, Jason P. Ross … (1991)

To determine the independent contributions of bone mass and existing fractures as predictors of the risk for new vertebral fractures. Postmenopausal Japanese-American women. Baseline measurements of the distal radius, the proximal radius, and the calcaneus were obtained in 1981 using single-photon absorptiometry. Measurements of the lumbar spine were obtained in 1984 using dual-photon absorptiometry. Prevalent vertebral fractures were identified using dimensions measured on lateral radiographs; vertebral height values more than 3 SD below vertebra-specific means were considered to indicate fracture. Statistical models were used to evaluate the utility of bone mass and existing (prevalent) fractures to predict the risk for new fractures during an average follow-up of 4.7 years. Differences of 2 SD in bone mass were associated with fourfold to sixfold increases in the risk for new vertebral fractures. A single fracture at the baseline examination increased the risk for new vertebral fractures fivefold. Presence of two or more fractures at baseline increased the risk 12-fold. A combination of low bone mass (below the 33d percentile) and the presence of two or more prevalent fractures increased the risk 75-fold, relative to women with the highest bone mass (above the 67th percentile) and no prevalent fractures. Stature, body mass index, arm span, and spinal conditions such as scoliosis, osteoarthritis, and sacroiliitis did not predict fracture incidence (P greater than 0.05). Weight was marginally predictive (P = 0.04) of fracture incidence but became nonpredictive after adjusting for bone mass (P greater than or equal to 0.05). Both bone mass and prevalent vertebral fractures are powerful predictors of the risk for new vertebral fractures. Combining information about bone mass and prevalent fracture appears to be better for predicting new fractures than either variable alone. Physicians can use these risk factors to identify patients at greatest risk for new fractures.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Neurosurg Soc

Journal ID (iso-abbrev): J Korean Neurosurg Soc

Journal ID (publisher-id): JKNS

Title: Journal of Korean Neurosurgical Society

Publisher: The Korean Neurosurgical Society

ISSN (Print): 2005-3711

ISSN (Electronic): 1598-7876

Publication date (Print): November 2013

Publication date (Electronic): 30 November 2013

Volume: 54

Issue: 5

Pages: 384-389

Affiliations

[1 ]Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.

[2 ]Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.

[3 ]Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.

[4 ]Department of Medical Statistics, Seoul National University Boramae Medical Center, Seoul, Korea.

[5 ]Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea.

Author notes

Address for reprints: Sung Bae Park, M.D. Department of Neurosurgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea. Tel: +82-2-870-3301, Fax: +82-2-870-3863, ddolbae01@ 123456naver.com

Article

DOI: 10.3340/jkns.2013.54.5.384

PMC ID: 3873350

PubMed ID: 24379944

SO-VID: 340d4f34-3434-440f-88f9-e5eb2a7f81a5

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 19 February 2013

Date revision received : 11 March 2013

Date accepted : 11 November 2013

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Correlation between Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry and Hounsfield Units Measured by Diagnostic CT in Lumbar Spine

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Most cited references 13

Prevention and management of osteoporosis.

Quantitative computed tomography.

Pre-existing fractures and bone mass predict vertebral fracture incidence in women.

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