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Hounsfield Unit-Calculated Bone Mineral Density Loss Following Combat-Related Lower Extremity Amputations
Benjamin W Hoyt1,2, Alexander E Lundy1, Donald F Colantonio1
1Department of Surgery at the Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland.
The Journal of Bone and Joint Surgery. American Volume
|August 15, 2023
Summary
Combat amputees experience rapid bone mineral density (BMD) loss, stabilizing around 3 years post-injury. A predictive model using CT scans can guide osteoporosis prophylaxis and clinical decisions.
Area of Science:
- Orthopedics
- Radiology
- Trauma Surgery
Background:
- Combat-related lower extremity amputations lead to significant bone mineral density (BMD) loss.
- Assessing BMD changes is challenging due to infrequent serial dual x-ray absorptiometry (DXA) scans.
- Computed tomography (CT) signal attenuation correlates strongly with DXA BMD, offering an alternative assessment method.
Approach:
- Leveraged multiple CT scans from trauma patients with lower extremity amputations (2003-2016).
- Collected clinical data including amputation level, complications, and time to weight-bearing.
- Developed a predictive model for BMD using CT-derived Hounsfield units (HU) and LASSO regression analysis.
Key Points:
- BMD loss occurred in both amputated and intact limbs, stabilizing approximately 3 years post-injury.
- Logarithmic BMD decline stabilized after 1,000 days, with amputated limbs losing ~100 HU.
- Predictive factors for lower BMD included nonambulatory status, age, surgical complications, and vitamin-D treatment.
Conclusions:
- Combat amputees experience rapid BMD decline influenced by modifiable and non-modifiable factors.
- A predictive model aids clinical decision-making for pre-operative planning and post-operative osteoporosis management.
- The model can optimize prophylaxis against osteoporosis in this patient population.
