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Correlation of Hounsfield Unit Measurements on Computed Tomography of the Shoulder With Dual-Energy X-ray Absorptiometry Scans and Fracture Risk Assessment Tool Scores : A Potential for Opportunistic Screening

Earp, Brandon E ; Kallini, Jennifer R ; Collins, Jamie E ; Benavent, Kyra A ; Tintle, Scott M LU orcid and Rozental, Tamara D (2021) In Journal of Orthopaedic Trauma 35(7). p.384-390
Abstract

BACKGROUND: The diagnosis of bone mineral density (BMD) abnormalities involves dual-energy x-ray absorptiometry (DXA), but few patients complete this after a fragility fracture. The assessment of BMD using Hounsfield unit (HU) measurements from computed tomography (CT) scans has been correlated with DXA results in previous studies. We aimed to evaluate the correlation between shoulder CT HU and DXA scores.

METHODS: Billing databases of 3 academic institutions were queried for patients who underwent both DXA and CT scan of the upper extremity within 1 year of each other. DXA T-scores for spine, hip, and femoral neck were recorded. BMD status was defined based on composite T-scores, using the lowest T-score in the spine, hip, or... (More)

BACKGROUND: The diagnosis of bone mineral density (BMD) abnormalities involves dual-energy x-ray absorptiometry (DXA), but few patients complete this after a fragility fracture. The assessment of BMD using Hounsfield unit (HU) measurements from computed tomography (CT) scans has been correlated with DXA results in previous studies. We aimed to evaluate the correlation between shoulder CT HU and DXA scores.

METHODS: Billing databases of 3 academic institutions were queried for patients who underwent both DXA and CT scan of the upper extremity within 1 year of each other. DXA T-scores for spine, hip, and femoral neck were recorded. BMD status was defined based on composite T-scores, using the lowest T-score in the spine, hip, or proximal femur. CT scans were measured for HU over 4 slices, recorded to create a bone column, then averaged. The patients' risks of major osteoporosis-related fracture and hip fracture were calculated using the Fracture Risk Assessment Tool.

RESULTS: In total, 300 patients were included. A positive correlation was found between composite T-scores and HU for glenoid and proximal humerus (0.36; 0.17). The proximal humerus HU was significantly associated with the BMD T-score for the hip (P = 0.01); the glenoid HU was significantly associated with BMD T-scores for the hip, spine, and femoral neck (P = 0.002; P = 0.001; P = 0.002). A 10-year risk of hip fracture >3% was associated with lower proximal humerus HU.

CONCLUSIONS: Our study is the first to discover significant correlations between HU at the glenoid and proximal humerus and risk factors as established by the Fracture Risk Assessment Tool scoring system.

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
subject
keywords
Absorptiometry, Photon, Bone Density, Humans, Osteoporosis/complications, Risk Assessment, Shoulder, Tomography, X-Ray Computed
in
Journal of Orthopaedic Trauma
volume
35
issue
7
pages
384 - 390
publisher
Wolters Kluwer Health
external identifiers
  • scopus:85108386116
  • pmid:33177427
ISSN
0890-5339
DOI
10.1097/BOT.0000000000001994
language
English
LU publication?
no
additional info
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
id
d7750b58-dc43-4730-8dd0-2dd4a4df20bb
date added to LUP
2024-11-14 09:50:03
date last changed
2025-06-27 23:38:25
@article{d7750b58-dc43-4730-8dd0-2dd4a4df20bb,
  abstract     = {{<p>BACKGROUND: The diagnosis of bone mineral density (BMD) abnormalities involves dual-energy x-ray absorptiometry (DXA), but few patients complete this after a fragility fracture. The assessment of BMD using Hounsfield unit (HU) measurements from computed tomography (CT) scans has been correlated with DXA results in previous studies. We aimed to evaluate the correlation between shoulder CT HU and DXA scores.</p><p>METHODS: Billing databases of 3 academic institutions were queried for patients who underwent both DXA and CT scan of the upper extremity within 1 year of each other. DXA T-scores for spine, hip, and femoral neck were recorded. BMD status was defined based on composite T-scores, using the lowest T-score in the spine, hip, or proximal femur. CT scans were measured for HU over 4 slices, recorded to create a bone column, then averaged. The patients' risks of major osteoporosis-related fracture and hip fracture were calculated using the Fracture Risk Assessment Tool.</p><p>RESULTS: In total, 300 patients were included. A positive correlation was found between composite T-scores and HU for glenoid and proximal humerus (0.36; 0.17). The proximal humerus HU was significantly associated with the BMD T-score for the hip (P = 0.01); the glenoid HU was significantly associated with BMD T-scores for the hip, spine, and femoral neck (P = 0.002; P = 0.001; P = 0.002). A 10-year risk of hip fracture &gt;3% was associated with lower proximal humerus HU.</p><p>CONCLUSIONS: Our study is the first to discover significant correlations between HU at the glenoid and proximal humerus and risk factors as established by the Fracture Risk Assessment Tool scoring system.</p><p>LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>}},
  author       = {{Earp, Brandon E and Kallini, Jennifer R and Collins, Jamie E and Benavent, Kyra A and Tintle, Scott M and Rozental, Tamara D}},
  issn         = {{0890-5339}},
  keywords     = {{Absorptiometry, Photon; Bone Density; Humans; Osteoporosis/complications; Risk Assessment; Shoulder; Tomography, X-Ray Computed}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{7}},
  pages        = {{384--390}},
  publisher    = {{Wolters Kluwer Health}},
  series       = {{Journal of Orthopaedic Trauma}},
  title        = {{Correlation of Hounsfield Unit Measurements on Computed Tomography of the Shoulder With Dual-Energy X-ray Absorptiometry Scans and Fracture Risk Assessment Tool Scores : A Potential for Opportunistic Screening}},
  url          = {{http://dx.doi.org/10.1097/BOT.0000000000001994}},
  doi          = {{10.1097/BOT.0000000000001994}},
  volume       = {{35}},
  year         = {{2021}},
}