A novel approach for assessing osteoporosis utilizing DXA, HU and VBQ

Abstract

Objective

To precisely assess preoperative osteoporosis in patients, a more precise method for evaluating osteoporosis is being developed to better guide the use of bone cement reinforced screws.

Method

The retrospective analysis was conducted on patients who underwent posterior lumbar decompression and fusion internal fixation at Shanghai Tongren Hospital.The general information, bone mineral density assessment data, Fracture risk prediction rate(WHO Fracture Risk Assessment Tool (FRAX)), and whether to use cement reinforced screws were collected. Definition of combination method: T value ​< ​−2.5 or HU value ​< ​110 or VBQ >3.5.The diagnostic rates of osteoporosis were compared between dual energy x-ray absorptiometry(DXA), Hounsfield Units(HU), Vertebral Bone Quality (VBQ), National Bone Health Alliance(NBHA), and combination methods, and the correlation between different methods was analyzed. Binary logistic regression was used to analyze the significant influencing factors of the use of cement-reinforced screws.

Result

A total of 178 patients were enrolled in the study, aged 65.73 ​± ​14.43 years, 121 female, 57 male, Body Mass Index(BMI) was 22.88 ​± ​3.52, 57 (32.0%) used cement reinforced screws, and 14 (7.9%) had previous fracture history.The diagnostic rates of osteoporosis by DXA, HU, VBQ, NBHA and combination method were 22.5% (40/178), 47.2% (84/178), 56.2% (100/178), 64.0% (114/178) and 75.8% (135/178), respectively.HU, VBQ, NBHA, and combination methods were significantly different from DXA in the diagnosis rate of osteoporosis (P ​< ​0.001). Binary Logistics regression showed that age, T value, HU value, and VBQ value significantly influenced bone cement screw use, and the odds ratio of VBQ was 4.315. The prediction accuracy of the regression equation was 90.4%, the area under the receiver operator characteristic(ROC) curve was 0.974, and the Youden index was 0.830.

Conclusion

Currently, the DXA method widely used for diagnosing osteoporosis yields false negative results and there are significant discrepancies among different diagnostic methods. The combined approach exhibits a higher detection rate (75.8%). Age, T value, HU value, and VBQ value significantly influence the use of cement screws with a regression equation accuracy of 90.4%. Cement-reinforced screws are recommended when osteoporosis is determined by a combination method.