Rationale and Objective
Sensitive detection of bone mineral density (BMD) change is a key issue to monitor and evaluate the individual bone health status, as well as bone metabolism and bone mineral status. The ability to use thoracic quantitative computed tomography (QCT) to detect the annual change of BMD remains unclear. We aimed to investigate the sensitivity in detecting age-related bone mineral loss using the thoracic QCT from the electrocardiographically gated heart scans in comparison to whole-body dual-energy X-ray absorptiometry (DXA) and standard lumbar QCT.
Materials and Methods
A total of 121 asymptomatic patients’ imaging data, including DXA whole body scan, cardiac CT scan, and abdomen scans were analyzed. The BMD of the thoracolumbar spine, upper, and lower extremities were measured using QCT and DXA, respectively. The age-related annual rate of bone density loss was computed and compared to the thoracic and lumbar QCT, as well DXA measures.
Results
The age-related annual rate of bone loss with QCT was −0.70 mg/mL 3 (−0.75%/y) in women, −0.83 mg/mL 3 (−0.86%/y) in men in the thoracic and the lumbar trabecular QCT, respectively. Compared to the QCT, DXA demonstrates a lower annual rate of bone loss in the area of BMD measurement ( P < .05 in all, excluding legs of women) in −0.45, −0.42, −0.67, and −0.46 in women, in −0.32, −0.02, −0.12, and −0.08 in men for thoracic, lumbar, leg, and arm, respectively.
Conclusion
We conclude that the thoracic and the lumbar QCT provide a similar and more sensitive method for detecting bone mineral loss when compared to DXA.
Introduction
Bone fracture and cardiovascular disease are two of the most common diseases and strongly associated with high morbidity and mortality. Osteoporosis and coronary atherosclerosis are crucial independent risk factors for bone fracture and cardiovascular disease, respectively , and both can be detected by quantitative computed tomography (QCT) using a low-dose cardiac CT-produced image . Given that the importance of using QCT to assess bone mineral density (BMD) of the spine may be a potentially diagnostic tool for osteoporosis-related vertebral fractures, several initial studies have indicated that the lumbar QCT is robust for the detection of osteoporosis, and BMD change can be more sensitively detected with serial scans . As a matter of fact, some preliminary thoracic QCT data from a routine lung or heart scan have indicated its compatibility with the lumbar QCT even if the sensitivity to detect the annual loss rate of BMD with the thoracic QCT remains unclear. In this study, we aimed to evaluate the ability to detect the age-related annual rate of bone loss by the thoracic QCT with an electrocardiographically gated routine heart scan in comparison to whole-body double-energy densitometry (DXA) and lumbar QCT.
Subject and Methods
Study Population
This chart review retrospective study comprises a total of 121 (56, 20–81 years) asymptomatic patients who underwent DXA whole-body and CT heart and abdomen scans on the same day. The aims of the study were the quantification of coronary calcified burden and examination of body composition, including bone mineral content (BMC), BMD, and percentage of the body fat and fat-free mass. The exclusion criteria are patients with metal implement in the thoracolumbar spine (only one case). All patients had optimal CT and DXA images with no significant noise or metal artifact.
CT Scan Technique
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QCT BMD Measurement, Coronary Calcium Burden Quantification, and Investigation in Spine Degenerative Change
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Whole-body DXA Scans and BMD Measurement
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Analysis
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Results
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TABLE 1
Demographic Characteristics Over Genders
Female ( n = 60) Male ( n = 61) Age (y) 57.7 ± 11.8 55.7 ± 11.9 Race, % Caucasian 4.5 5.5 Hispanic 34.1 34.5 African-American 52.3 47.3 Asian 9.1 12.7 Height (cm) 158.5 ± 9.5 170.4 ± 11.0 Weight (kg) 71.4 ± 17.2 86.5 ± 20.1 Body mass index (kg/m 2 ) 28.1 ± 5.4 26.8 ± 5.2 Agatston score 109 ± 313 377 ± 512 Total fat percentage (%) 36.2 ± 7.9 25.0 ± 7.9 Total free-rat mass (%) 61.0 ± 7.6 71.9 ± 7.6 Total bone mineral content (%) 2.7 ± 0.5 3.0 ± 0.5
TABLE 2
The Age-related Annual Rate of Bone Loses (%/y) Over Genders with QCT and DXA
Female ( n = 60) Male ( n = 61) β 95% CI β 95% CI QCT Thoracic TRAB, %/y −0.70 −2.50, 1.11 −0.83 −3.12, 1.47 QCT Lumbar TRAB,%/y −0.75 −2.22, 0.74 −0.86 −2.7, 0.97 DXA Thoracic, %/y −0.45 \* −1.67, 0.92 −0.32 † −2.41, 1.77 DXA Lumbar, %/y −0.42 \* −1.45, 0.75 −0.02 † −0.24, 0.19 DXA Legs, %/y −0.67 −1.90, 0.56 −0.12 † −0.31, 0.08 DXA Arms, %/y −0.46 \* −0.57, 0.65 −0.08 † −0.24, 0.07
CI, confidence interval; DXA, dual-energy X-ray absorptiometry; QCT, quantitative computed tomography; TQCT, thoracic quantitative computed tomography; TRAB, trabecular bone.
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TABLE 3
The Correlation Between BMD Assessment and Weight or Age
Female Male Weight Age Weight Age QCT Thoracic TRAB 0.26 \* −0.55 † 0.07 −0.47 † QCT Lumbar TRAB 0.02 −0.62 † 0.08 −0.45 † DXA Thoracic 0.50 † −0.13 0.41 † 0.27 \* DXA Lumbar 0.55 † −0.25 0.34 † 0.30 \* DXA Legs 0.34 † −0.27 \* 0.36 † 0.04 DXA Arms 0.23 −0.19 0.32 † 0.14
BMD, bone mineral densaity; DXA, dual-energy X-ray absorptiometry; QCT, quantitative computed tomography; TRAB, trabecular bone.
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TABLE 4
Bone Mineral Density and T-score of Women Across Age Categories
Total ( n = 60) Age (Y) Trend P Value <50 ( n = 14) 50–64 ( n = 24) ≥65 ( n = 22) QCT Thoracic TRAB (mg/cc) 172.1 ± 53.2 216.4 ± 41.3 178.4 ± 52.6 137.0 ± 33.1 <.001 QCT Thoracic T-score −1.2 ± 1.7 0.0 ± 1.5 −1.1 ± 1.5 −2.4 ± 0.9 <.001 QCT Lumbar TRAB (mg/cc) 133.9 ± 42.5 174.8 ± 31.8 139.5 ± 31.0 108.4 ± 38.5 <.001 QCT Lumbar T-score −1.2 ± 1.7 −0.2 ± 1.6 −1.3 ± 1.0 −2.2 ± 1.3 <.001 DXA Thoracic (g/cm 2 ) 0.75 ± 0.12 0.75 ± 0.12 0.78 ± 0.12 0.72 ± 0.09 .462 DXA Thoracic T-score −1.1 ± 1.2 −1.0 ± 1.3 −0.9 ± 1.3 −1.5 ± 0.8 .231 DXA Lumbar (g/cm 2 ) 0.98 ± 0.16 1.00 ± 0.15 1.02 ± 0.14 0.91 ± 0.12 .046 DXA Lumbar T-score −0.8 ± 1.2 −0.6 ± 1.2 −0.6 ± 1.3 −1.3 ± 1.3 .062 DXA Legs (g/cm 2 ) 0.95 ± 0.15 0.99 ± 0.15 0.97 ± 0.13 0.92 ± 0.15 .193 DXA Legs T-score −1.8 ± 1.4 −1.6 ± 1.4 −1.7 ± 1.4 −2.1 ± 1.3 .363 DXA Arms (g/cm 2 ) 0.64 ± 0.10 0.67 ± 0.08 0.65 ± 0.08 0.62 ± 0.1.2 .222 DXA Arms T-score −1.5 ± 1.2 −1.0 ± 1.3 −1.4 ± 1.1 −1.9 ± 1.1 .052
DXA, dual-energy X-ray absorptiometry; QCT, quantitative computed tomography; TRAB, trabecular bone.
The patient’s weight was adjusted when the difference within groups was tested.
TABLE 5
Bone Mineral Density and T-score of Men Across Age Categories
Total ( n = 61) Age (Y) Trend P Value <50 ( n = 23) 50–64 ( n = 25) ≥65 ( n = 13) QCT Thoracic TRAB (mg/mL 3 ) 174.3 ± 55.3 198.8 ± 54.9 168.0 ± 51.5 143.3 ± 42.0 .003 QCT Thoracic T-score −1.2 ± 1.5 −0.2 ± 1.4 −1.4 ± 1.3 −2.2 ± 0.9 <.001 QCT Lumbar TRAB (mg/mL 3 ) 131.9 ± 39.4 142.7 ± 40.3 138.7 ± 41.9 116.4 ± 34.4 .042 QCT Lumbar T-score −1.4 ± 1.0 −0.1 ± 1.3 −1.1 ± 0.8 −2.0 ± 0.7 <.001 DXA Thoracic (g/cm 2 ) 0.84 ± 0.12 0.82 ± 0.09 0.84 ± 0.14 0.88 ± 0.16 .242 DXA Thoracic T-score −0.4 ± 1.3 −0.7 ± 1.0 −0.3 ± 1.2 0.0 ± 1.6 .014 DXA Lumbar (g/cm 2 ) 1.04 ± 0.16 1.03 ± 0.14 1.01 ± 0.17 1.10 ± 0.15 .213 DXA Lumbar T-score −0.2 ± 1.2 −0.4 ± 1.0 −0.3 ± 1.3 0.2 ± 1.1 .113 DXA Legs (g/cm 2 ) 1.12 ± 0.14 1.13 ± 0.12 1.10 ± 0.15 1.09 ± 0.13 .737 DXA Legs T-score −1.5 ± 1.0 −1.4 ± 0.8 −1.6 ± 1.1 −1.6 ± 1.0 .655 DXA Arms (g/cm 2 ) 0.78 ± 0.08 0.78 ± 0.08 0.76 ± 0.09 0.76 ± 0.07 .315 DXA Arms T-score −1.4 ± 1.0 −1.2 ± 1.1 −1.5 ± 1.0 −1.5 ± 1.0 .421
DXA, dual-energy X-ray absorptiometry; QCT, quantitative computed tomography; TRAB, trabecular bone.
The patient’s weight was adjusted when the difference within groups was tested.
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Discussion
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Limitation
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Conclusion
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