The Suitable Population for Opportunistic Low Bone Mineral Density Screening Using Computed Tomography

Abstract

Objective

To explore the suitable population of CT value for predicting low bone mineral density (low-BMD).

Methods

A total of 1268 patients who underwent chest CT examination and DXA within one-month period retrospectively analyzed. The CT attenuation values of trabecular bone were measured in mid-sagittal plane from thoracic vertebra 7 (T7). Receiver operating characteristic (ROC) curves were used to evaluate the ability to diagnose low-BMD.

Results

The AUC for diagnosing low BMD was larger in women than in men (0.894 vs 0.744, p < 0.05). The AUC increased gradually with the increase of age but decreased gradually with the increase in height and weight (p < 0.05). In females, when specificity was adjusted to approximately 90%, a threshold of 140.25 HU has a sensitivity of 69.3%, which is higher than the sensitivity of 36.5% in males for distinguishing low-BMD from normal. At the age of 70 or more, when specificity was adjusted to approximately 90%, a threshold of 126.31 HU has a sensitivity of 76.1%, which was higher than that of other age groups.

Conclusion

For patients who had completed chest CTs, the CT values were more effective in predicting low-BMD in female, elderly, lower height, and lower weight patients.

Keywords:

• bone mineral density
• chest computed tomography
• dual-energy X-ray absorptiometry
• attenuation value

Ethical Approval

This study was approved by the institutional review board of the First Hospital of Nanchang in compliance with the Helsinki and an exemption from the informed consent was obtained (IRB No. KY2022024). All data were anonymized before the analysis to safeguard patient privacy.

Acknowledgments

This study supported by the Science and Technology Program of Health Commission of Jiangxi Province (No.202211611 to ZPZ), the Science and Technology Bureau of Nanchang City (Hongkezi 2019 No.258-5 to ZPZ) and the Science and Technology Bureau of Nanchang City (Hongkezi 2021 No.129-4 to ZPZ).

Disclosure

The authors report no conflicts of interest in this work.