Comparative Diagnostic Performance of Cone Beam Computed Tomography and Dual-Energy X-Ray Absorptiometry for Low Bone Density Assessment. A Systematic Review and Meta-Analysis

Abstract

Objective

This systematic review evaluated the diagnostic accuracy of CBCT for BMD assessment using DEXA as the reference standard and aimed to quantify its performance through meta-analysis.

Materials and Methods

This review included prospective and retrospective observational studies assessing CBCT's diagnostic performance in detecting low BMD, with DEXA as the reference. Searches in PubMed, Embase, and Scopus identified 13 eligible studies involving adult participants (≥ 18 years). Two reviewers independently extracted data and assessed study quality using the QUADAS-2 tool. Meta-analysis was conducted using random-effects models.

Results

Pooled sensitivity and specificity of CBCT for detecting low BMD were 0.58 (95% CI: 0.50–0.67) and 0.78 (95% CI: 0.69–0.86), respectively. The summary receiver operating characteristic (SROC) curve showed an area under the curve (AUC) of 0.73 (95% CI: 0.69–0.77), indicating moderate diagnostic accuracy. Subgroup analyses revealed heterogeneity influenced by sample size and anatomical site.

Conclusion

CBCT demonstrates moderate diagnostic accuracy in detecting low BMD, with better specificity than sensitivity. While promising, standardization of CBCT protocols and larger studies are needed to confirm its role in clinical assessment.

PROSPERO Registration Number

(CRD42024598958).