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Reliability and validity of lower extremity computed tomography as a screening tool for osteoporosis

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Abstract

Summary

We evaluated the correlation between central bone mineral density (BMD) and peripheral bone attenuation using lower extremity computed tomography (CT). A good correlation was found between lower extremity CT and central BMD suggesting that CT is useful for screening osteoporosis, and that peripheral bone attenuation adequately reflects central BMD.

Introduction

This study aimed to evaluate the reliability and validity of CT as a screening tool for osteoporosis and to estimate the correlation between central BMD and peripheral bone attenuation using lower extremity CT.

Methods

In total, 292 patients who underwent a lower extremity, lumbar spine, or abdomen and pelvic CT scan within a 3-month interval of a dual-energy X-ray absorptiometry (DEXA) examination were included. Following reliability testing, bone attenuation of the L1, L2, L3, L4, femoral head, femoral neck, greater trochanter, distal femur, proximal tibia, distal tibia, and talus was measured by placing a circular region of interest on the central part of each bony region on a coronal CT image. Partial correlation was used to assess the correlation between CT and DEXA after adjusting for age and body mass index.

Results

In terms of reliability, all bone attenuation measurements, except the femoral neck, showed good to excellent interobserver reliability (intraclass correlation coefficients, 0.691–0.941). In terms of validity, bone attenuation of the L1 to L4, femoral neck, and greater trochanter on CT showed significant correlations with BMD of each area on DEXA (correlation coefficients, 0.399–0.613). Bone attenuation of the distal tibia and talus on CT showed significant correlations with BMD of all parts on DEXA (correlation coefficients, 0.493–0.581 for distal tibia, 0.396–0.579 for talus).

Conclusion

Lower extremity CT is a useful screening tool for osteoporosis, and peripheral bone attenuation on lower extremity CT adequately reflects central BMD on DEXA.

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Conflicts of interest

None.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

This study was exempt from the approval of the institutional review board of our institution because it involved no human subjects.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea

    S. Y. Lee

  2. Biomedical Research Institute, Seoul National University Bundang Hospital, Gyeonggi, South Korea

    S.-S. Kwon

  3. Department of Orthopaedic Surgery, Myongji Hospital, 55 Hwasu-ro 14beon-gil, Deokyang-gu, Goyang-si, Gyeonggi-do, 463-707, South Korea

    H. S. Kim, J. H. Yoo, J. Kim, J. Y. Kim, B. C. Min, S. J. Moon & K. H. Sung

Authors
  1. S. Y. Lee
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  2. S.-S. Kwon
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  3. H. S. Kim
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  4. J. H. Yoo
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  5. J. Kim
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  6. J. Y. Kim
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  7. B. C. Min
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  8. S. J. Moon
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  9. K. H. Sung
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Corresponding author

Correspondence to K. H. Sung.

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Appendix I

Scatter plot for correlations between bone attenuation on computed tomography and bone mineral density on dual-energy X-ray absorptiometry in the same anatomic region (GIF 68 kb)

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Lee, S.Y., Kwon, SS., Kim, H.S. et al. Reliability and validity of lower extremity computed tomography as a screening tool for osteoporosis. Osteoporos Int 26, 1387–1394 (2015). https://doi.org/10.1007/s00198-014-3013-x

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  • DOI: https://doi.org/10.1007/s00198-014-3013-x

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