Opportunistic Computed Tomography: A Novel Opportunity for Osteoporosis Screening.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2024-10-29 DOI:10.1097/BSD.0000000000001710

Jared Reid, Jacqueline Tobin, Matthew McCrosson, Gabriella Rivas, Stacey Rothwell, Robert Ravinsky, James Lawrence

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Abstract

Study design: Retrospective review.

Objective: To use opportunistic computed tomography (CT) screening to determine the prevalence of osteoporosis (OP) in patients presenting with spinal fractures and the rate of identification and treatment at our institution.

Background: OP remains a highly underdiagnosed and undertreated disease. Opportunistic abdominopelvic CT scans offer a feasible, accessible, and cost-effective screening tool for OP.

Methods: Retrospective review of 519 patients presenting as trauma activation to the emergency department of a Level 1 Trauma Center after a spinal fracture. Patients were excluded if under the age of 18 or lacking a CT scan upon arrival in the emergency department. Hounsfield Units (HU) were measured at the L1 vertebral level on CT scans to determine bone density levels. Values of ≤100 HU were considered osteoporotic, whereas 101-150 HU were osteopenic.

Results: A total of 424 patients were included. The average HU was 204.8 ± 74.3 HU. Of the patients, 16.7% were diagnosed as osteopenic and 9.9% as osteoporotic. The mean age was 65 ± 14 years for osteopenic patients and 77 ± 11 years for osteoporotic. A statistically significant inverse relationship was found between age and bone density. Of the patients, 42.5% with low bone density HU measurements had a previously documented history of OP/osteopenia. There was a statistically significant association between females and low bone density. Patients injured in a fall were statistically significantly more likely to have lower bone densities than those in motor vehicle accidents. Of the osteoporotic patients, 9.5% were treated by our institution's fragility fracture team.

Conclusions: Our study shows that among a cohort of patients with spinal fractures, 58% of patients with radiographic signs of OP are currently undiagnosed, resulting in a low treatment rate of OP. Increasing and standardizing the use of opportunistic CT scans would allow an increase in the diagnosis and treatment of OP in patients with spinal fractures. Further, opportunistic CT scans could also be useful for a broader orthopedic population at high risk of fragility fractures.

Level of evidence: Level II-therapeutic.

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机会性计算机断层扫描：骨质疏松症筛查的新机遇

研究设计回顾性研究：利用机会性计算机断层扫描（CT）筛查确定脊柱骨折患者中骨质疏松症（OP）的患病率，以及本院的识别率和治疗率：背景：骨质疏松症仍然是一种诊断率低、治疗率低的疾病。机会性腹部盆腔 CT 扫描为 OP 提供了一种可行、方便且经济有效的筛查工具：方法：回顾性分析 519 名因脊柱骨折到一级创伤中心急诊科就诊的创伤激活患者。未满 18 岁或到达急诊科时未进行 CT 扫描的患者排除在外。在 CT 扫描中测量 L1 椎骨水平的 Hounsfield 单位（HU），以确定骨密度水平。测量值≤100 HU为骨质疏松，101-150 HU为骨质疏松：结果：共纳入 424 名患者。平均 HU 值为 204.8 ± 74.3 HU。其中 16.7% 的患者被诊断为骨质疏松，9.9% 的患者被诊断为骨质疏松。骨质疏松患者的平均年龄为 65 ± 14 岁，骨质疏松症患者的平均年龄为 77 ± 11 岁。经统计发现，年龄与骨密度之间存在明显的反比关系。在接受 HU 测量的低骨密度患者中，42.5% 曾有过 OP/骨质疏松病史。据统计，女性与低骨密度之间存在明显的关联。据统计，摔伤患者骨密度较低的几率明显高于车祸患者。在骨质疏松症患者中，9.5%的患者接受了本机构脆性骨折小组的治疗：我们的研究表明，在脊柱骨折患者群体中，58%有OP影像学表现的患者目前未被诊断，导致OP治疗率较低。增加并规范机会性 CT 扫描的使用将有助于提高脊柱骨折患者 OP 的诊断和治疗率。此外，机会性 CT 扫描还可用于更广泛的脆性骨折高危骨科人群：证据等级：二级-治疗

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.