Associations between bone attenuation and prevalent vertebral fractures on chest CT scans differ with vertebral fracture locations

J H M Driessen, M J van Dort, E A P M Romme, E F M Wouters, F W J M Smeenk, B van Rietbergen, J P W van den Bergh, P Geusens, J H M Driessen, M J van Dort, E A P M Romme, E F M Wouters, F W J M Smeenk, B van Rietbergen, J P W van den Bergh, P Geusens

Abstract

Vertebral fracture (VF) locations are bimodally distributed in the spine. The association between VF and bone attenuation (BA) measured on chest CT scans varied according to the location of VFs, indicating that other factors than only BA play a role in the bimodal distribution of VFs.

Introduction: Vertebral fractures (VFs) are associated with low bone mineral density but are not equally distributed throughout the spine and occur most commonly at T7-T8 and T11-T12 ("cVFs") and less commonly at T4-T6 and T9-T10 ("lcVF"). We aimed to determine whether associations between bone attenuation (BA) and VFs vary between subjects with cVFs only, with lcVFs only and with both cVFs and lcVFs.

Methods: Chest CT images of T4-T12 in 1237 smokers with and without COPD were analysed for prevalent VFs according to the method described by Genant (11,133 vertebrae). BA (expressed in Hounsfield units) was measured in all non-fractured vertebrae (available for 10,489 vertebrae). Linear regression was used to compare mean BA, and logistic regression was used to estimate the association of BA with prevalent VFs (adjusted for age and sex).

Results: On vertebral level, the proportion of cVFs was significantly higher than of lcVF (5.6% vs 2.0%). Compared to subjects without VFs, BA was 15% lower in subjects with cVFs (p < 0.0001), 25% lower in subjects with lcVFs (p < 0.0001) and lowest in subjects with cVFs and lcVFs (- 32%, p < 0.0001). The highest ORs for presence of VFs per - 1SD BA per vertebra were found in subjects with both cVFs and lcVFs (3.8 to 4.6).

Conclusions: The association between VFs and BA differed according to VF location. ORs increased from subjects with cVFs to subjects with lcVFs and were highest in subjects with cVFs and lcVFs, indicating that other factors than only BA play a role in the bimodal VF distribution.

Trial registration: Clinicaltrials.gov identifier: NCT00292552.

Keywords: Bone attenuation; CT scans; Vertebral fractures.

Conflict of interest statement

J.H.M. Driessen, M.J. van Dort, E.A.P.M. Romme, F.W.J.M. Smeenk and B. van Rietbergen declare that they have no conflict of interest.

E.F.M. Wouters reports board membership at Boehringer, grants and speaker fees from AstraZeneca, grants and speaker fees from GSK, speaker fees from Novartis and speaker fees from Chiesi, outside the submitted work.

J.P.W. van den Bergh reports grants from Eli Lilly, grants from Will Pharma and grants from Amgen, outside the submitted work.

P. Geusens reports grants, speaker fees and advisory board from Amgen, grants from Pfizer, grants from MSD, grants from UCB, grants from Abbott, grants and speaker fees from Lilly, grants from BMS, grants from Novartis, grants from Roche and grants from Will Pharma, outside the submitted work.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Proportion of prevalent VFs (a) and prevalent VFs according to severity (b) at vertebrae T4–T12 on chest CT scans. Abbreviations: VF = vertebral fracture
Fig. 2
Fig. 2
Comparison of total BA between subjects without a VF and subjects with VFs according to the regions of VF locations. Differences between groups were adjusted for age and sex. There was a significant trend in the gradual lower BA from no VFs towards cVFs and lcVFs combined. Abbreviations: BA, bone attenuation; VF, vertebral fracture; cVF, prevalent vertebral fracture at common location (T7–T8, T11–T12); lcVF, prevalent vertebral fracture at less common location (T4–T6, T9–T10)
Fig. 3
Fig. 3
a Mean (with standard error of the mean) local bone attenuation stratified by the presence of vertebral fractures and b mean (with standard error of the mean) local bone attenuation stratified by the presence and location of vertebral fractures. Abbreviations: VF, vertebral fracture; HU, Hounsfield units; cVF, prevalent vertebral fracture at common location (T7–T8, T11–T12); lcVF, prevalent vertebral fracture at less common location (T4–T6, T9–T10)

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