Using opportunistic screening with abdominal CT to identify osteoporosis and osteopenia in patients with diabetes

Jain, R. K.; Lee, E.; Mathai, C.; Dako, F.; Gogineni, P.; Weiner, M. G.; Vokes, T.

Affiliations

¹Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, USA

²Lewis Katz School of Medicine at Temple University, Philadelphia, USA

³Section of Endocrinology, Diabetes, and Metabolism, Temple University Hospital, Philadelphia, USA

⁴Department of Radiology, University of Maryland Medical Center, Baltimore, USA

⁵Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, USA

⁶Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, USA

Abstract and keywords

Summary: Opportunistic osteoporosis screening involves measuring the attenuation of L1 vertebrae on abdominal computed tomography (CT), which correlates with DXA T-score. We found that this approach is useful for detecting low bone mass in patients with diabetes and propose L1 attenuation ≤ 135 Hounsfield units (HU) as a threshold for which DXA should be strongly considered.

Introduction: Attenuation of the L1 vertebrae on computer tomography (CT) images done for other reasons (“Opportunistic Osteoporosis Screening”) has been found to correlate well with DXA-derived T-score. However, the method and the thresholds have never been tested specifically in those with diabetes mellitus (DM), in whom the fracture risk is greater than explained by BMD.

Methods: In a retrospective study of subjects with DM who had both abdominal CT and DXA within 6 months of each other, we compared L1 attenuation and DXA T-score to define the sensitivity and specificity of thresholds previously established in the general population.

Results: There were 313 subjects among whom 18 (5.8%) had prior major osteoporotic fracture (MOF). Subjects with MOF had lower T-scores (− 2.3 ± 1.4 vs. − 0.9 ± 1.4, p < 0.001) and L1 attenuation (104 HU ± 46 vs. 149 HU ± 47, p < 0.001) than non-fracture subjects. L1 attenuation ≤ 160 HU was 91% sensitive for osteoporosis, while ≤ 110 HU was 80% specific. For a higher T-score of ≤ − 1.5, L1 attenuation ≤ 135 HU showed balanced sensitivity and specificity (65% and 69%, respectively).

Conclusion: Opportunistic osteoporosis screening with abdominal CT is useful in determining the need for DXA screening in subjects with diabetes. We propose L1 attenuation ≤ 135 HU as a reasonable threshold for detecting the T-score of ≤ − 1.5, which is likely associated with increased fragility in DM.

Keywords: Diabetes; L1 attenuation; Opportunistic screening

Links

DOI: 10.1007/s00198-020-05521-x

PubMed: 32623489

WoS: 000545298700001

History

Received: 2020-04-21

Accepted: 2020-06-25

Online: 2020-07-05

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