Longitudinal Association between L1 Trabecular Attenuation from Chest Computed Tomography (CT) and Bone Mineral Density from Dual-energy X-ray Absorptiometry (DXA)

Background Many studies have shown that vertebral trabecular attenuation measured on CT scan corresponds well to DXA results for bone mineral density. These studies were based on cross-sectional data. Hence, there were limitations in explaining the constantly changing vertebral trabecular attenuation from CT and T-score from DXA over time. Objective This study aimed to determine the longitudinal association between the vertebral trabecular attenuation measured on computed tomography (CT) and the T-score measured by dual-energy X-ray absorptiometry (DXA). Methods We performed a database search for 333 patients who underwent surgery for breast cancer, preoperative treatment, and at least one follow-up chest CT and DXA from January, 2013 through May, 2021. One musculoskeletal radiologist measured the mean vertebral trabecular attenuation of lumbar vertebra 1(L1) on axial unenhanced images at the pedicle level by manually placing the region of interest (ROI). DXA of the lumbar spine was performed, and the lowest T-score of the lumbar spine was used for the analysis. We evaluated the association between L1 trabecular attenuation from chest CT and T-score from DXA over time using the generalized estimating equations (GEE) model to analyze longitudinal corrected data. Results A total of 150 women (mean age, 52.4 ± 11.0 years) were included. There was a statistically significant association between L1 trabecular attenuation from chest CT and T-score from DXA in the unadjusted model (p < 0.001) and adjusted model (p < 0.001). T-score value increased by 0.172 (95% confidence interval (CI): 0.145-0.200, p < 0.001) per 10 unit (HU) of L1 trabecular attenuation at time = 0 in unadjusted model and by 0.173 (95% CI: 0.143-0.203, p < 0.001) in all adjusted model. Conclusion We demonstrated that L1 attenuation from chest CT images was longitudinally associated with T-score from DXA, and the degree of association appeared to be decreased over time in breast cancer patients regardless of their medical condition.

[1]  A. Foldes,et al.  Opportunistic screening for osteoporosis and osteopenia by routine computed tomography scan: A heterogeneous, multiethnic, middle-eastern population validation study. , 2021, European journal of radiology.

[2]  Jeong Ho Kim,et al.  Opportunistic use of chest CT for screening osteoporosis and predicting the risk of incidental fracture in breast cancer patients: A retrospective longitudinal study , 2020, PloS one.

[3]  M. Weiner,et al.  Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes , 2020, Osteoporosis International.

[4]  Timothy J Ziemlewicz,et al.  Opportunistic Osteoporosis Screening at Routine Abdominal and Thoracic CT: Normative L1 Trabecular Attenuation Values in More than 20 000 Adults. , 2019, Radiology.

[5]  R. Roden,et al.  Evaluation of osteopenia and osteoporosis in younger breast cancer survivors compared with cancer-free women: a prospective cohort study , 2018, Breast Cancer Research.

[6]  J. Boone,et al.  Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift , 2018, Current Rheumatology Reports.

[7]  M. Law,et al.  Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population , 2018, Archives of Osteoporosis.

[8]  Benedict U. Nwachukwu,et al.  Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment: A Qualitative Systematic Review , 2017, The Journal of bone and joint surgery. American volume.

[9]  P. Pickhardt,et al.  Opportunistic Screening for Osteoporosis Using Body CT Scans Obtained for Other Indications: the UW Experience , 2017, Clinical Reviews in Bone and Mineral Metabolism.

[10]  M. Beland,et al.  Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients , 2017, Osteoporosis International.

[11]  P. Bearcroft,et al.  The reliability of measuring the density of the L1 vertebral body on CT imaging as a predictor of bone mineral density. , 2017, Clinical radiology.

[12]  Anouk L. M. Eikendal,et al.  Inter-observer and inter-examination variability of manual vertebral bone attenuation measurements on computed tomography , 2016, European Radiology.

[13]  Pim A. de Jong,et al.  Opportunistic screening for osteoporosis on routine computed tomography? An external validation study , 2015, European Radiology.

[14]  L. Strong,et al.  Long-term risk of medical conditions associated with breast cancer treatment , 2014, Breast Cancer Research and Treatment.

[15]  P. Pickhardt,et al.  Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications , 2013, Annals of Internal Medicine.

[16]  M. K. Garg,et al.  Dual energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density , 2013, Indian journal of endocrinology and metabolism.

[17]  M. Roberts,et al.  Cost-Effectiveness of Different Screening Strategies for Osteoporosis in Postmenopausal Women , 2011, Annals of Internal Medicine.

[18]  P. Pickhardt,et al.  Simultaneous screening for osteoporosis at CT colonography: Bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard , 2011, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[19]  J. Cauley,et al.  Ethnic difference of clinical vertebral fracture risk , 2011, Osteoporosis International.

[20]  A. Tosteson,et al.  Incidence and Economic Burden of Osteoporosis‐Related Fractures in the United States, 2005–2025 , 2007, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[21]  Rashmi Kumar,et al.  NCCN Task Force Report: Bone Health in Cancer Care. , 2006, Journal of the National Comprehensive Cancer Network : JNCCN.

[22]  C. Ritenbaugh,et al.  Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer , 2005, Cancer.

[23]  K. Baek,et al.  Official Positions of the International Society for Clinical Densitometry. , 2005 .

[24]  Susan R. Johnson,et al.  Osteoporosis prevention, diagnosis, and therapy. , 2001, JAMA.

[25]  J. Adams,et al.  Low bone mineral density in adults with cystic fibrosis , 1999, Thorax.

[26]  M. Olschewski,et al.  Bone loss after kidney transplantation: a longitudinal study in 115 graft recipients. , 1995, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.