Distribution of bone voids in the thoracolumbar spine in Chinese adults with and without osteoporosis:​ a cross-sectional multi-center study based on 464 vertebrae

Lin, Junyu; Liu, Zhuojie; Fu, Guangtao; Zhang, Haiyan; Chen, Chong; Qi, Huan; Jiang, Kanghui; Zhang, Cheng; Ma, Chi; Yang, Kedi; Wang, Chenmin; Tan, Baoyu; Zhu, Qingan; Ding, Yue; Li, Chunhai; Zheng, Qiujian; Cai, Daozhang; Lu, William Weijia

Affiliations

¹Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, PR China

²Department of Orthopaedics, The University of Hong Kong–Shenzhen Hospital, Shenzhen, PR China

³Department of Orthopaedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China

⁴Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, RP, China

⁵Department of Orthopaedics, Academy of Orthopedics⋅Guangdong Province, Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Guangzhou, RP, China

⁶Bone's Technology Limited, Hong Kong

⁷Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, PR China

⁸Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, PR China

Abstract and keywords

Bone void is a novel intuitive morphological indicator to assess bone quality but its use in vertebrae has not been described. This cross-sectional and multi-center study aimed to investigate the distribution of bone voids in the thoracolumbar spine in Chinese adults based on quantitative computed tomography (QCT). A bone void was defined as a trabecular net region with extremely low bone mineral density (BMD) (<40 mg/cm³), detected by an algorithm based on phantom-less technology. A total of 464 vertebrae from 152 patients (51.8 ± 13.4 years old) were included. The vertebral trabecular bone was divided into eight sections based on the middle sagittal, coronal, and horizontal planes. Bone void of the whole vertebra and each section were compared between healthy, osteopenia, and osteoporosis groups and between spine levels. Receiver operator characteristic (ROC) curves were plotted and optimum cutoff points of void volume between the groups were obtained. The total void volumes of the whole vertebra were 124.3 ± 221.5 mm³, 1256.7 ± 928.7 mm³, and 5624.6 ± 3217.7 mm³ in healthy, osteopenia, and osteoporosis groups, respectively. The detection rate of vertebrae with bone voids was higher and the normalized void volume was larger in the lumbar than in thoracic vertebrae. L3 presented the largest void (2165.0 ± 3396.0 mm³), while T12 had the smallest void (448.9 ± 699.4 mm³). The bone void was mainly located in the superior-posterior-right section (40.8 %). Additionally, bone void correlated positively with age and increased rapidly after 55 years. The most significant void volume increase was found in the inferior-anterior-right section whereas the least increase was found in the inferior-posterior-left section with aging. The cutoff points were 345.1 mm³ between healthy and osteopenia groups (sensitivity = 0.923, specificity = 0.932) and 1693.4 mm³ between osteopenia and osteoporosis groups (sensitivity = 1.000, specificity = 0.897). In conclusion, this study demonstrated the bone void distribution in vertebrae using clinical QCT data. The findings provide a new perspective for the description of bone quality and showed that bone void could guide clinical practice such as osteoporosis screening.

Keywords: Bone void; Vertebra; Thoracolumbar spine; Osteoporosis; Section

Links

DOI: 10.1016/j.bone.2023.116749

PubMed: 36972755

WoS: 000976656600001

History

Received: 2022-12-1

Revised: 2023-03-7

Accepted: 2023-03-22

Online: 2023-03-25

Cited Works (5)

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