Frontiers in Medical Science Research, 2025, 7(3); doi: 10.25236/FMSR.2025.070309.
Yali Zou, Runhua Zhou
Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
Osteoporosis is a common metabolic bone disease, and early bone mineral density (BMD) assessment is essential for timely intervention. Although dual-energy X-ray absorptiometry (DXA) is the diagnostic gold standard, its accuracy may be affected by spinal degenerative changes. Hounsfield unit (HU) measurements from thoracic CT scans offer a potential alternative for opportunistic screening, yet the consistency across different CT manufacturers remains unclear.This retrospective study included 207 patients who underwent thoracic CT and DXA within 60 days. Patients were grouped by CT manufacturer: Toshiba (n = 120), United Imaging (n = 57), and Siemens Healthineers (n = 30). HU values at T10 were measured, excluding cases with metabolic bone disease or image artifacts. One-way ANOVA compared HU values among groups, and Pearson correlation evaluated associations with the lowest DXA T-score.Mean HU values were: Toshiba 191.8 ± 60.55, United Imaging 172.8 ± 58.62, Siemens 172.2 ± 63.77 (P = 0.081). HU values correlated significantly with T-scores (r = 0.6213–0.6588), with no significant intergroup differences (P = 0.940).Thoracic HU values are consistent across CT devices and correlate well with BMD, supporting their use as a reliable, cost-effective tool for opportunistic osteoporosis screening.
Osteoporosis, Bone Mineral Density (BMD), Hounsfield Unit (HU), Thoracic CT
Yali Zou, Runhua Zhou. Predicting Osteoporosis Using Thoracic Spine HU Values from Chest CT: Validation Across Multiple CT Scanner Vendors. Frontiers in Medical Science Research (2025), Vol. 7, Issue 3: 68-73. https://doi.org/10.25236/FMSR.2025.070309.
[1] Anam AK, Insogna K. Update on Osteoporosis Screening and Management. Med Clin North Am. 2021;105(6):1117-1134.
[2] Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med. 2020;17(8):e1003180.
[3] Zhang J, Luo X, Zhou R, et al. The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia. Clin Radiol. 2023;78(10):763-771.
[4] US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521-2531.
[5] Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study . Bone. 2004;34(1):195-202.
[6] Muraki S, Yamamoto S, Ishibashi H, et al. Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int. 2004;15(9):724-728.
[7] Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588-595.
[8] Summers RM, Baecher N, Yao J, et al. Feasibility of simultaneous computed tomographic colonography and fully automated bone mineral densitometry in a single examination. J Comput Assist Tomogr. 2011;35(2):212-216.
[9] Romme EA, Murchison JT, Phang KF, et al. Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res. 2012;27(11):2338-2343.
[10] Zhang J, Luo X, Zhou R, et al. The Suitable Population for Opportunistic Low Bone Mineral Density Screening Using Computed Tomography. Clin Interv Aging. 2024;19:807-815.
[11] Dell R, Greene D. Is osteoporosis disease management cost effective. Curr Osteoporos Rep. 2010;8(1):49-55.
[12] Dipaola CP, Bible JE, Biswas D, Dipaola M, Grauer JN, Rechtine GR. Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis. Spine J. 2009;9(7):537-544.
[13] Perrier-Cornet J, Omorou AY, Fauny M, Loeuille D, Chary-Valckenaere I. Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporos Int. 2019;30(6):1215-1222.
[14] Sacks D, Baxter B, et al. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. Int J Stroke. 2018;13(6):612-632.
[15] Shuhart CR, Yeap SS, Anderson PA, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom. 2019;22(4):453-471.
[16] Chen M, Gerges M, Raynor WY, et al. State of the Art Imaging of Osteoporosis. Semin Nucl Med. 2024;54(3):415-426.
[17] Garner HW, Paturzo MM, Gaudier G, Pickhardt PJ, Wessell DE. Variation in Attenuation in L1 Trabecular Bone at Different Tube Voltages: Caution Is Warranted When Screening for Osteoporosis With the Use of Opportunistic CT. AJR Am J Roentgenol. 2017;208(1):165-170.
[18] Yang J, Liao M, Wang Y, et al. Opportunistic osteoporosis screening using chest CT with artificial intelligence. Osteoporos Int. 2022;33(12):2547-2561.
[19] Amin MFM, Zakaria WMW, Yahya N. Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA. Skeletal Radiol. 2021; 50(12):2525-2535.
[20] Ohara T, Hirai T, Muro S, et al. Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest. 2008;134(6):1244-1249.