Which Indicator Among Lumbar Vertebral Hounsfield Unit, Vertebral Bone Quality, or Dual-Energy X-Ray Absorptiometry-Measured Bone Mineral Density Is More Efficacious in Predicting Thoracolumbar Fragility Fractures?

Neurospine, 2023 · DOI: https://doi.org/10.14245/ns.2346998.499 · Published: December 1, 2023

Surgery Orthopedics Musculoskeletal Medicine

Simple Explanation

This study looks at different ways to predict fractures in the spine caused by weak bones. It compares Hounsfield units (HU) from CT scans, vertebral bone quality (VBQ) from MRI, and bone mineral density (BMD) from DEXA scans to see which is best at predicting these fractures. Researchers measured HU, VBQ, and BMD in patients with and without these fractures. They then analyzed which measurement was the best predictor. The study found that HU from CT scans was the most accurate predictor, followed by BMD from DEXA scans. VBQ from MRI was also a predictor but not as strong as the other two.

Study Duration

January 2019 and June 2023

Participants

156 patients (78 with thoracolumbar fragility fractures, 78 with degenerative spinal diseases)

Evidence Level

Not specified

Key Findings

1
Lumbar vertebral HU exhibited a positive correlation with BMD (p < 0.01).
2
VBQ showed a negative correlation with HU, BMD (p < 0.05).
3
HU (AUC = 0.863) showcasing the highest predictive efficacy, followed by the DEXA-measured BMD (AUC = 0.813).

Research Summary

The study aimed to determine which indicator—lumbar vertebral Hounsfield units (HU), vertebral bone quality (VBQ), or bone mineral density (BMD)—is most effective in predicting thoracolumbar fragility fractures. The results indicated that HU exhibited the highest predictive efficacy, followed by DEXA-measured BMD, while VBQ demonstrated the lowest predictive efficacy. The study concludes that while all three indicators can predict thoracolumbar fragility fractures, HU is the most effective, suggesting its potential as a primary screening tool.

Practical Implications

Enhanced Fracture Prediction

Using HU measurements from routine CT scans can improve the prediction of thoracolumbar fragility fractures.

Cost-Effective Screening

Leveraging existing CT data for HU measurements provides a cost-effective method for identifying high-risk individuals.

Targeted Preventive Measures

Identifying at-risk individuals enables the implementation of timely preventive measures to reduce fracture incidence.

Study Limitations

1
The research only included patients scheduled for spinal surgery.
2
The study primarily focused on thoracolumbar fragility fractures and may not be able to predict fragility fractures in other anatomical regions.
3
This research is retrospective in nature and included a relatively small sample of 156 patients.

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