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Measurement of Distal Ulnar Hounsfield Units Accurately Predicts Bone Mineral Density of the Forearm

Wagner, Scott C ; Dworak, Theodora C ; Grimm, Patrick D ; Balazs, George C and Tintle, Scott M LU orcid (2017) In The Journal of bone and joint surgery. American volume 99(8).
Abstract

BACKGROUND: Hounsfield unit (HU) measurement obtained from computed tomography (CT) scans of the wrist is a potential new screening method for low bone mineral density (BMD). We hypothesized that HU measurements of the ulnar head obtained from CT scans would correlate with BMD assessed with dual x-ray absorptiometry (DXA) scans of the forearm.

METHODS: Patients with both upper-extremity CT and DXA scans performed at a single institution were included in the study. Hounsfield units were manually measured in the distal part of the ulna by 1 author blinded to the DXA results. Average values were then compared with forearm BMD values as determined with a DXA scan.

RESULTS: Seventy-seven CT scans of 74 patients were included.... (More)

BACKGROUND: Hounsfield unit (HU) measurement obtained from computed tomography (CT) scans of the wrist is a potential new screening method for low bone mineral density (BMD). We hypothesized that HU measurements of the ulnar head obtained from CT scans would correlate with BMD assessed with dual x-ray absorptiometry (DXA) scans of the forearm.

METHODS: Patients with both upper-extremity CT and DXA scans performed at a single institution were included in the study. Hounsfield units were manually measured in the distal part of the ulna by 1 author blinded to the DXA results. Average values were then compared with forearm BMD values as determined with a DXA scan.

RESULTS: Seventy-seven CT scans of 74 patients were included. Average HU values were significantly lower in the osteoporotic and osteopenic groups in comparison with the normal BMD group. The upper limit of the 95% confidence interval for osteopenic patients was 145.9 HU. The average forearm T-score for patients with an HU value at or below the cutoff of 146 was significantly lower than the average T-score for those with an HU value of >146 HU (p < 0.0001). Sensitivity and negative predictive value for low BMD using this cutoff value were calculated to be 91% and 89%, respectively.

CONCLUSIONS: Distal ulnar HU measurements accurately reflect the BMD of the forearm as diagnosed with a DXA scan. Our results suggest that distal ulnar HU measurements of ≤146 HU are strongly associated with low BMD and that values above this cutoff accurately rule out low forearm BMD with a high degree of sensitivity and negative predictive value. Utilizing this technique may improve the capture of at-risk patients and streamline the screening process for osteoporosis.

LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
Absorptiometry, Photon, Bone Density/physiology, Bone Diseases, Metabolic/diagnostic imaging, Female, Forearm, Humans, Male, Middle Aged, Osteoporosis/diagnostic imaging, Sensitivity and Specificity, Tomography, X-Ray Computed, Ulna/diagnostic imaging
in
The Journal of bone and joint surgery. American volume
volume
99
issue
8
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85019598062
  • pmid:28419040
ISSN
1535-1386
DOI
10.2106/JBJS.15.01244
language
English
LU publication?
no
id
d7394603-70c0-4746-97e7-5206b3a477e8
date added to LUP
2024-11-14 09:55:28
date last changed
2025-04-18 17:01:52
@article{d7394603-70c0-4746-97e7-5206b3a477e8,
  abstract     = {{<p>BACKGROUND: Hounsfield unit (HU) measurement obtained from computed tomography (CT) scans of the wrist is a potential new screening method for low bone mineral density (BMD). We hypothesized that HU measurements of the ulnar head obtained from CT scans would correlate with BMD assessed with dual x-ray absorptiometry (DXA) scans of the forearm.</p><p>METHODS: Patients with both upper-extremity CT and DXA scans performed at a single institution were included in the study. Hounsfield units were manually measured in the distal part of the ulna by 1 author blinded to the DXA results. Average values were then compared with forearm BMD values as determined with a DXA scan.</p><p>RESULTS: Seventy-seven CT scans of 74 patients were included. Average HU values were significantly lower in the osteoporotic and osteopenic groups in comparison with the normal BMD group. The upper limit of the 95% confidence interval for osteopenic patients was 145.9 HU. The average forearm T-score for patients with an HU value at or below the cutoff of 146 was significantly lower than the average T-score for those with an HU value of &gt;146 HU (p &lt; 0.0001). Sensitivity and negative predictive value for low BMD using this cutoff value were calculated to be 91% and 89%, respectively.</p><p>CONCLUSIONS: Distal ulnar HU measurements accurately reflect the BMD of the forearm as diagnosed with a DXA scan. Our results suggest that distal ulnar HU measurements of ≤146 HU are strongly associated with low BMD and that values above this cutoff accurately rule out low forearm BMD with a high degree of sensitivity and negative predictive value. Utilizing this technique may improve the capture of at-risk patients and streamline the screening process for osteoporosis.</p><p>LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>}},
  author       = {{Wagner, Scott C and Dworak, Theodora C and Grimm, Patrick D and Balazs, George C and Tintle, Scott M}},
  issn         = {{1535-1386}},
  keywords     = {{Absorptiometry, Photon; Bone Density/physiology; Bone Diseases, Metabolic/diagnostic imaging; Female; Forearm; Humans; Male; Middle Aged; Osteoporosis/diagnostic imaging; Sensitivity and Specificity; Tomography, X-Ray Computed; Ulna/diagnostic imaging}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{8}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{The Journal of bone and joint surgery. American volume}},
  title        = {{Measurement of Distal Ulnar Hounsfield Units Accurately Predicts Bone Mineral Density of the Forearm}},
  url          = {{http://dx.doi.org/10.2106/JBJS.15.01244}},
  doi          = {{10.2106/JBJS.15.01244}},
  volume       = {{99}},
  year         = {{2017}},
}