title: Screening for osteoporosis after trauma: a new approach using quantitative computed tomography of the skull.
abstract: BACKGROUND
  The diagnosis of osteoporosis is important in the care of elderly patients at risk of trauma. While pelvis computed tomography (CT) is accurate in the measurement of bone mineral density, axial skull CT has not previously been evaluated for this purpose. This study investigated whether data from axial skull CT scans can screen for osteoporosis.
  
  
  METHODS
  Bone density measurements were derived from digital analysis of routine scans of the head and pelvis using quantitative CT. The study took place from October 2010 to November 2011 at a medium-sized community hospital. The first study phase included patients older than 18 years who had both a head and a pelvis CT scan within 30 days. The known diagnostic value for osteoporosis on pelvis CT scans was used to derive a diagnostic value for head CT. The second study phase included adult trauma patients who underwent noncontrast head CT during an initial trauma evaluation. A subgroup analysis was performed during Phase II on patients older than 65 years to identify the incidence of fracture as it is affected by age and bone mineral density.
  
  
  RESULTS
  Our data demonstrated that head CT was able to identify osteoporosis with a sensitivity of 0.70, a specificity of 0.81, and an accuracy of 0.76 compared with pelvic CT. Of 261 trauma patients, 54% had bone disease based on axial skull CT criteria. Patients older than 65 years with a positive screen result for osteoporosis on head CT were twice as likely to have a fracture.
  
  
  CONCLUSIONS
  Analysis of data from head CT scans has the potential to provide a useful screen for osteoporosis. Adding this analysis to CT scans performed for elderly trauma patients could result in improved diagnosis and treatment of osteoporosis.
  
  
  METHODS
  Diagnostic study, level II.
authors.affiliation: From the Santa Barbara Cottage Hospital (A.T., J.G., S.Y.), Santa Barbara; Department of Surgery (K.W.), Ventura County Health System, Ventura, California; and San Antonio Colon and Rectal Clinic (S.I.), San Antonio, Texas.
authors.forename: Amber
authors.initials: A
authors.lastname: Taylor
authors.forename: Kenneth
authors.initials: K
authors.lastname: Waxman
authors.forename: Seema
authors.initials: S
authors.lastname: Izfar
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grotts
authors.forename: Samantha
authors.initials: S
authors.lastname: Yim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D058866:Osteoporotic Fractures / Q000453:epidemiology; D011446:Prospective Studies; D012886:Skull / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*