title: Opportunistic Osteoporosis Screening - Gleaning Additional Information from Diagnostic Wrist CT Scans.
abstract: BACKGROUND
  Although screening for and treating osteoporosis can prevent subsequent fractures, the rates of such interventions are low following a distal radial fracture. One potential method for identifying metabolic bone disease is via Hounsfield unit (HU) measurements from diagnostic computed tomography (CT) scans. We hypothesized that HU values of the distal aspect of the radius could be used to assess local bone quality and would be predictive of distal radial fracture risk, thereby allowing the identification of patients in need of further management.
  
  
  METHODS
  Measurements of bone mineral density (BMD) were made for 100 patients on the basis of HU values of cancellous portions of the distal aspect of the radius, the ulnar head, and the capitate. The HU values in twenty-five male and twenty-five female patients with an acute distal radial fracture documented on CT were compared with those of age and sex-matched control patients who had a CT scan obtained for other indications.
  
  
  RESULTS
  Among the control patients, HU values decreased as age increased. When assessed on the basis of sex, both male and female patients with a distal radial fracture had significantly lower regional BMD compared with nonfracture control patients. A distal radial HU value of 218 for females and 246 for males optimized sensitivity and specificity; values below this threshold were associated with an increased risk of distal radial fracture.
  
  
  CONCLUSIONS
  HU measurements can be obtained from any diagnostic CT scan using modern software programs and can be obtained by physicians in the office setting with minimal effort and at no additional cost or radiation exposure to the patient. Regardless of imaging indications, we suggest that patients with HU values below the identified thresholds be considered for further metabolic bone disease work-up, such as additional imaging, laboratory assessments, the initiation of osteoporosis treatment, or appropriate referral.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.G. Carlson: carlsonm@hss.edu.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Schreiber
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.G. Carlson: carlsonm@hss.edu.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Gausden
authors.affiliation: University of Wisconsin, 1685 Highland Avenue, 6th Floor, Madison, WI 53705-2281.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.G. Carlson: carlsonm@hss.edu.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Carlson
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.G. Carlson: carlsonm@hss.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Weiland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D051224:Capitate Bone; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014457:Ulna; D014955:Wrist Joint / Q000000981:diagnostic imaging*; D055815:Young Adult