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Using Hounsfield Units to Assess Osteoporotic Status on Wrist CT Scans: A Missed Opportunity?
Christine Cleora Johnson, MD; Elizabeth B. Gausden, MD; Andrew J. Weiland, MD; Joseph M. Lane, MD; Joseph J. Schreiber, MD
Hospital for Special Surgery, New York, NY

Background: The rates of evaluation and treatment for osteoporosis following distal radius fragility fractures remain low. Detecting osteoporosis from a diagnostic computed tomography (CT) scan at the time of injury would allow for a timely diagnosis and may prompt intervention to help prevent a subsequent fracture. The purpose of this study was to determine if Hounsfield unit (HU) measurements at the capitate correlated with bone mineral density (BMD) measurements of the hip, femoral neck, and lumbar spine, and to assess the ability of these HU measurements to detect osteoporosis of the hip.

Methods: The cohort included forty-five female patients with a distal radius fracture who underwent CT scan and dual x-ray absorptiometry (DXA) scan as part of the management of their wrist fracture. Bone density measurements were made using the regional cancellous bone HU value at the capitate and compared to values obtained by a DXA scan.

Results: HU values at the capitate correlated with bone mineral density (BMD) and t-scores at the femoral neck and hip (p<0.0001). HU values at the capitate were also associated with BMD and t-scores at the lumbar spine (p=0.001 and p=0.002 respectively). A HU threshold of 307 in the capitate optimized sensitivity (86%) and specificity (94%) for discerning patients with osteoporosis from patients with a normal t-score with an odds ratio of 14.6 (p=0.0013).

Conclusions: By demonstrating that capitate HU measurements from clinical CT scans are correlated with BMD and t-scores at the hip, femoral neck, and lumbar spine, our data suggests that clinical CT scans may have a role in detecting osteopenia and osteoporosis. Furthermore, our results suggest that intervention for osteoporosis should be considered in female patients with a Hounsfield unit measurement of 307 or less at the capitate.

Level of Evidence: Level II Diagnostic

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