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X-ray-based quantitative osteoporosis imaging at the spine

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Abstract

Osteoporosis is a metabolic bone disease with a high prevalence that affects the population worldwide, particularly the elderly. It is often due to fractures associated with bone fragility that the diagnosis of osteoporosis becomes clinically evident. However, early diagnosis would be necessary to initiate therapy and to prevent occurrence of further fractures, thus reducing morbidity and mortality. X-ray-based imaging plays a key role for fracture risk assessment and monitoring of osteoporosis. Whereas over decades dual-energy X-ray absorptiometry (DXA) has been the main method used and still reflects the reference standard, another modality reemerges with quantitative computed tomography (QCT) because of its three-dimensional advantages and the opportunistic exploitation of routine CT scans. Against this background, this article intends to review and evaluate recent advances in the field of X-ray-based quantitative imaging of osteoporosis at the spine. First, standard DXA with the recent addition of trabecular bone score (TBS) is presented. Secondly, standard QCT, dual-energy BMD quantification, and opportunistic BMD screening in non-dedicated CT exams are discussed. Lastly, finite element analysis and microstructural parameter analysis are reviewed.

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Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

Abbreviations

BMD:

Bone mineral density

CBM:

Cortical bone mapping

CV:

Coefficient of variation

DXA:

Dual-energy X-ray absorptiometry

DECT:

Dual-energy computed tomography

FEA:

Finite element analysis

FRAX:

Fracture Risk Algorithm

HU:

Hounsfield units

HRCT:

High-resolution computed tomography

MDCT:

Multi-detector computed tomography

ICC:

Interclass correlation coefficient

QCT:

Quantitative computed tomography

SDCT:

Spectral detector computed tomography

SIR:

Statistical iterative reconstruction

SPM:

Statistical parametric mapping

TBS:

Trabecular bone score

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    M.T. Löffler, N. Sollmann, A. Valentinitsch, J.S. Kirschke & T. Baum

  2. Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    K. Mei

  3. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    P.B. Noël

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  1. M.T. Löffler
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  2. N. Sollmann
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  3. K. Mei
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  4. A. Valentinitsch
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  6. J.S. Kirschke
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Löffler, M., Sollmann, N., Mei, K. et al. X-ray-based quantitative osteoporosis imaging at the spine. Osteoporos Int 31, 233–250 (2020). https://doi.org/10.1007/s00198-019-05212-2

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