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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Osteoporosis | Research article

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

Authors: Congyang Xue, Xiaopei Lu, Guangda Sun, Nan Wang, Ganshen He, Wenqiang Xu, Zhipeng Xi, Lin Xie

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases.

Methods

We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis.

Results

Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18.

Conclusion

T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation.

Trial registration

retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022.

Knezevic NN, Candido KD, Vlaeyen J, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78–92. https://doi.org/10.1016/S0140-6736(21)00733-9.CrossRefPubMed

Gadjradj PS, Rubinstein SM, Peul WC, Depauw PR, Vleggeert-Lankamp CL, Seiger A, et al. Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022;376:e65846. https://doi.org/10.1136/bmj-2021-065846.CrossRef

Alpert JN. Review of the diagnosis and management of lumbar spinal stenosis. JAMA. 2022;328(8):779–80. https://doi.org/10.1001/jama.2022.11384.CrossRefPubMed

Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and management of lumbar spinal stenosis: a review. JAMA. 2022;327(17):1688–99. https://doi.org/10.1001/jama.2022.5921.CrossRefPubMed

Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021;385(6):526–38. https://doi.org/10.1056/NEJMoa2100990.CrossRefPubMed

Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413–23. https://doi.org/10.1056/NEJMoa1513721.CrossRefPubMed

Pu X, Wang X, Ran L, Xie T, Li Z, Yang Z, et al. Comparison of predictive performance for cage subsidence between ct-based hounsfield units and mri-based vertebral bone quality score following oblique lumbar interbody fusion. Eur Radiol. 2023. https://doi.org/10.1007/s00330-023-09929-x.CrossRefPubMed

Chang HK, Ku J, Ku J, Kuo YH, Chang CC, Wu CL, et al. Correlation of bone density to screw loosening in dynamic stabilization: an analysis of 176 patients. Sci Rep. 2021;11(1):17519. https://doi.org/10.1038/s41598-021-95232-y.CrossRefPubMedPubMedCentral

Allen RT, Lee YP, Garfin SR. Spine surgeons survey on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis. Spine J. 2009;9(7):602–4. https://doi.org/10.1016/j.spinee.2009.05.002.CrossRefPubMed

10.

Prevention and management of osteoporosis. World Health Organ Tech Rep Ser. 2003;921:1–164.

11.

Zaidi Q, Danisa OA, Cheng W. Measurement techniques and utility of hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine (Phila Pa 1976). 2019;44(4):E239–44. https://doi.org/10.1097/BRS.0000000000002813.CrossRefPubMed

12.

Neuner JM, Binkley N, Sparapani RA, Laud PW, Nattinger AB. Bone density testing in older women and its association with patient age. J Am Geriatr Soc. 2006;54(3):485-9. https://doi.org/10.1111/j.1532-5415.2005.00622. x.

13.

Ehresman J, Pennington Z, Schilling A, Lubelski D, Ahmed AK, Cottrill E, et al. Novel mri-based score for assessment of bone density in operative spine patients. Spine J. 2020;20(4):556–62. https://doi.org/10.1016/j.spinee.2019.10.018.CrossRefPubMed

14.

Pinto EM, Neves JR, Teixeira A, Frada R, Atilano P, Oliveira F, et al. Efficacy of hounsfield units measured by lumbar computer tomography on bone density assessment: a systematic review. Spine (Phila Pa 1976. 2022;47(9):702–10. https://doi.org/10.1097/BRS.0000000000004211.CrossRefPubMed

15.

Buckens CF, Dijkhuis G, de Keizer B, Verhaar HJ, de Jong PA. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study. Eur Radiol. 2015;25(7):2074–9. https://doi.org/10.1007/s00330-014-3584-0.CrossRefPubMed

16.

Kuo CC, Soliman M, Aguirre AO, Ruggiero N, Kruk M, Khan A, et al. Strong correlation between the vertebral bone quality score and the cervical-vertebral bone quality score in spine surgery patients. World Neurosurg. 2023. https://doi.org/10.1016/j.wneu.2023.02.112.CrossRefPubMed

17.

Huang Y, Chen Q, Liu L, Feng G. Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion. J Orthop Surg Res. 2023;18(1):258. https://doi.org/10.1186/s13018-023-03729-1.CrossRefPubMedPubMedCentral

18.

Ehresman J, Schilling A, Pennington Z, Gui C, Chen X, Lubelski D, et al. A novel mri-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. J Neurosurgery: Spine. 2020;32(4):499–506. https://doi.org/10.3171/2019.9.CrossRef

19.

Pu M, Zhong W, Heng H, Yu J, Wu H, Jin Y et al. Vertebral bone quality score provides preoperative bone density assessment for patients undergoing lumbar spine surgery: a retrospective study. J Neurosurg Spine 2023:1–10. https://doi.org/10.3171/2023.1. SPINE221187.

20.

Ozmen E, Bicer O, Meric E, Circi E, Baris A, Yuksel S. Vertebral bone quality score for opportunistic osteoporosis screening: a correlation and optimal threshold analysis. Eur Spine J. 2023;32(11):3906–11. https://doi.org/10.1007/s00586-023-07912-0.CrossRefPubMed

21.

Dell R, Greene D. Is osteoporosis disease management cost effective? Curr Osteoporos Rep. 2010;8(1):49–55. https://doi.org/10.1007/s11914-010-0009-0.CrossRefPubMed

22.

Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Screening for osteoporosis to prevent fractures: us preventive services task force recommendation statement. JAMA. 2018;319(24):2521–31. https://doi.org/10.1001/jama.2018.7498.CrossRefPubMed

23.

Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39(4):619–26. https://doi.org/10.1007/s00296-019-04273-0.CrossRefPubMed

24.

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):1215–22. https://doi.org/10.1007/s00198-019-04931-w.CrossRefPubMed

25.

Huang W, Gong Z, Wang H, Zheng C, Chen Y, Xia X, et al. Use of mri-based vertebral bone quality score (vbq) of s1 body in bone mineral density assessment for patients with lumbar degenerative diseases. Eur Spine J. 2023;32(5):1553–60. https://doi.org/10.1007/s00586-023-07643-2.CrossRefPubMed

26.

Xu TT, Huang XY, Jiang YW. Efficacy of two opportunistic methods for screening osteoporosis in lumbar spine surgery patients. Eur Spine J. 2023;32(11):3912–8. https://doi.org/10.1007/s00586-023-07938-4.CrossRefPubMed

27.

Zhang L, Luo X, Liu H, Zhu W, Zhang X, Zhu S, et al. Prevalence and risk factors of osteoporosis and osteopenia among residents in hubei province, China. Arch Osteoporos. 2023;18(1):49. https://doi.org/10.1007/s11657-023-01245-7.CrossRefPubMed

28.

Guo W, Li BL, Zhao JY, Li XM, Wang LF. Causal associations between modifiable risk factors and intervertebral disc degeneration. Spine J 2023. https://doi.org/10.1016/j.spinee.2023.10.021.

29.

Wang J, Shu B, Tang DZ, Li CG, Xie XW, Jiang LJ, et al. The prevalence of osteoporosis in China, a community-based cohort study of osteoporosis. Front Public Health. 2023;11:1084005. https://doi.org/10.3389/fpubh.2023.1084005.CrossRefPubMedPubMedCentral

Title: Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach
Authors: Congyang Xue
Xiaopei Lu
Guangda Sun
Nan Wang
Ganshen He
Wenqiang Xu
Zhipeng Xi
Lin Xie
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Osteoporosis
Osteoporosis
Degenerative Disease
Dexamethasone
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04782-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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