Low-Dose CT Scans Offer Opportunity to Screen Older Patients for Osteoporosis

November 4, 2020
Patrick Campbell

An analysis of data from more than 65k patients suggests low-dose CT scans could provide an opportunity to screen for osteoporosis in older patients.

New research from a team of investigators at the Peking University School of Medicine in China suggests low-dose computed tomography (LDCT) imaging tests performed as part of screening for other diseases could lead to improved identification of osteoporosis.

An analysis of data from more than 69k patients suggests use of LDCT imaging tests derived from lung cancer screenings could help identify patients with osteoporosis who may otherwise go unnoticed.

"Our large scale, multi-center study of bone density measured from routine LDCT scans demonstrated the great potential of using LDCT for the opportunistic screening of osteoporosis as an alternative to standard DXA scans," said lead investigator Wei Tian, MD, of the Chinese Academy of Engineering and the Peking University School of Medicine, in a statement. "Our study revealed the unexpectedly high prevalence of osteoporosis in men, which may impact on the management strategy of men in the future."

With an interest in identifying opportunities to screen adult patients for osteoporosis and other conditions, Tian and a team of colleagues sought to explore whether use of thoracic LDCT could aid in the identification of patients with osteoporosis. To do so, investigators designed their study as an analysis of data from the China Biobank Study—with data from this study, investigators hoped to retrospectively assess lumbar spine trabecular volumetric BMD.

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Of note, assessments of lumbar spine trabecular volumetric BMD were performed from the LDCT scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis.

Using a study period of June 2018-June 2019, investigators identified 69,095 participants from the China Biobank study who underwent low-dose chest CT scans for inclusion in their analysis. Of these, 40,733 were men and 28,362 were women. Men had a mean age of 49±12.7 years and women had a mean age of 49.6±14.6 years.

After age-standardization using the 2010 Chinese Census Data, investigators estimated the prevalence of osteoporosis for the Chinese population aged 50 years and over was 29.0% among women and 13.5% among men. In comparison to recent prevalence data using dual-energy X-ray absorptiometry (DXA) diagnosis, rates of prevalence appeared comparable in women but prevalence in men was double (6.46% vs 13.53%).

Results indicated trabecular volumetric BMD decreased with age in both men and women. Women in the study had a higher peak trabecular volumetric BMD than men (185.4 mg/cm3 vs 176.6 mg/cm3) from age 30-34. At the age 80, men had a higher trabecular volumetric BMD than women (92.1 mg/cm3 vs 62.4 mg/cm3).

“We show that LDCT-based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses,” wrote study investigators.

This study, “Opportunistic Screening Using Low-Dose CT and the Prevalence of Osteoporosis in China: A Nationwide, Multicenter Study,” was published in the Journal of Bone and Mineral Research.