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Thoracic Bone Mineral Density Derived from Cardiac CT Is Associated with Greater Fracture Rate
Josephine Therkildsen1, Louise Nissen1, Hanne S Jørgensen1
1From the Department of Cardiology, Hospital Unit West, Gl.landevej 61, Herning 7400, Denmark (J. Therkildsen, L.N., M.B., S.W.); Laboratory of Nephrology, Department of Immunology and Microbiology, KU Leuven-University of Leuven, Belgium (H.S.J.); Department of Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark (J. Thygesen); Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark (P.I.); Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (L.F.); Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark (C.I.); Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark (B.L.L.); Department of Rheumatology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Denmark (E.M.H., H.S.J.); and Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.W.).
Insights
Cardiac CT scans can assess thoracic bone mineral density (BMD) to identify individuals at higher risk of fractures. Very low BMD significantly increases the rate of both any fracture and osteoporosis-related fractures.
Area of Science:
- Radiology
- Orthopedics
- Cardiology
Background:
- Osteoporosis is a common, treatable condition often diagnosed late, leading to increased fracture risk.
- Bone mineral density (BMD) assessment is crucial for identifying fracture risk.
- Cardiac CT scans offer a potential method for evaluating thoracic BMD.
Purpose of the Study:
- To investigate the association between thoracic bone mineral density (BMD) measured via cardiac CT and subsequent fracture rates.
- To determine if cardiac CT-derived BMD can predict incident fractures.
Main Methods:
- A prospective cohort study included 1487 participants undergoing cardiac CT.
- Quantitative CT software measured volumetric BMD of three thoracic vertebrae.
- Fracture outcomes were tracked via the National Patient Registry over a median follow-up of 3.1 years.
Main Results:
- 12.0% of participants had very low BMD (<80 mg/cm³).
- Very low BMD was associated with a significantly higher rate of any incident fracture (adjusted HR, 2.1) and osteoporosis-related fractures (adjusted HR, 4.0).
- These associations remained significant after adjusting for age and sex.
Conclusions:
- Routine cardiac CT can be utilized to measure thoracic BMD.
- This measurement can help identify individuals with low BMD and elevated fracture risk.
- Cardiac CT provides a valuable tool for opportunistic osteoporosis screening.
Abstract:
Background Osteoporosis is a prevalent, under-diagnosed, and treatable disease associated with increased fracture risk. Bone mineral density (BMD) derived from cardiac CT may be used to determine fracture rate. Purpose To assess the association between fracture rate and thoracic BMD derived from cardiac CT. Materials and Methods This prospective cohort study included consecutive participants referred for cardiac CT for evaluation of ischemic heart disease between September 2014 and March 2016. End of follow-up was June 30, 2018. In all participants, volumetric BMD of three thoracic vertebrae was measured by using quantitative CT software. The primary and secondary outcomes were any incident fracture and any incident osteoporosis-related fracture registered in the National Patient Registry, respectively. Hazard ratios were assessed by using BMD categorized as very low (<80 mg/cm3), low (80-120 mg/cm3), or normal (>120 mg/cm3). The study is registered at ClinicalTrials.gov (identifier: NCT02264717). Results In total, 1487 participants (mean age, 57 years ± 9; age range, 40-80 years; 52.5% women) were included, of whom 179 (12.0%) had very low BMD. During follow-up (median follow-up, 3.1 years; interquartile range, 2.7-3.4 years; range, 0.2-3.8 years), 80 of 1487 (5.3%) participants were diagnosed with an incident fracture and in 31 of 80 participants, the fracture was osteoporosis related. In unadjusted Cox regressions analyses, very low BMD was association with a greater rate of any fracture (hazard ratio, 2.6; 95% confidence interval [CI]: 1.4, 4.7; P = .002) and any osteoporosis-related fracture (hazard ratio, 8.1; 95% CI: 2.4, 26.7; P = .001) compared with normal BMD. After adjusting for age and sex, very low BMD remained associated with any fracture (hazard ratio, 2.1; 95% CI: 1.1, 4.2) and any osteoporosis-related fracture (hazard ratio, 4.0; 95% CI: 1.1, 14.6). Conclusion Routine cardiac CT can be used to help measure thoracic bone mineral density (BMD) to identify individuals who have low BMD and a greater fracture rate. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Bredella in this issue.
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