title: Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence.
abstract: OBJECTIVE
  Low bone quality is a contributing factor to motor vehicle crash (MVC) injury. Quantification of occupant bone mineral density (BMD) is important from an injury causation standpoint. The first aim of this study was to validate a technique for measuring lumbar volumetric BMD (vBMD) from phantomless computed tomography (CT) scans. The second aim was to apply the validated phantomless technique to quantify lumbar vBMD in Crash Injury Research and Engineering Network (CIREN) occupants for correlation with age, fracture incidence, and osteopenia/osteoporosis diagnoses.
  
  
  METHODS
  Quantitative CT (qCT) and dual-energy X-ray absorptiometry (DXA) were collected prospectively for 50 subjects and used to validate a technique to measure vBMD from 281 phantomless CT scans of CIREN occupants. Hounsfield unit (HU) measurements were collected from the L1-L5 vertebrae, right psoas major muscle, and anterior subcutaneous fat for all subjects and from 3 phantom ports with known mg/cc calcium hydroxyapatite values for the validation group. qCT calibration was accomplished using regressions between the phantom HU and mg/cc values to convert L1-L5 HU values to mg/cc. A phantomless calibration technique was developed where the fat and muscle HU values were linearly regressed against fat (-69 mg/cc) and muscle (77 mg/cc) to establish a conversion for L1-L5 HU measurements to mg/cc. vBMD calculated from qCT versus the phantomless method was compared for the 50 subjects to assess agreement and a mg/cc osteopenia threshold was established using DXA T-scores. CIREN HU measurements were converted to mg/cc using the phantomless technique and the mg/cc osteopenia threshold was used to compare vBMD to age, fracture incidence, and osteopenia comorbidity classifications in CIREN.
  
  
  RESULTS
  Linear regression of lumbar vBMD derived from the qCT versus phantomless calibrations showed excellent agreement (R(2) = 0.87, P <.0001). A 145 mg/cc threshold for osteopenia was established (sensitivity = 1, specificity = 0.57) and 44 CIREN occupants had vBMD below this threshold. Of these 44 occupants, 64% were not classified as osteopenic in CIREN, but vBMD suggested undiagnosed osteopenia. Age was negatively correlated with vBMD in both sexes (P <.0001) and CIREN occupants with less than 145 mg/cc vBMD sustained an average 1.7 additional rib/sternum fractures (P =.036).
  
  
  CONCLUSIONS
  Because lumbar vBMD was estimated from phantomless CT scans with accuracy similar to qCT, the phantomless technique can be broadly applied to both prospectively and retrospectively assess patient bone quality for research and clinical studies related to MVCs, falls, and aging.
authors.affiliation: a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina.|b Wake Forest School of Medicine , Winston-Salem , North Carolina.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Weaver
authors.affiliation: c Wake Forest University, Health and Exercise Science , Winston-Salem , North Carolina.
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Beavers
authors.affiliation: a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina.|b Wake Forest School of Medicine , Winston-Salem , North Carolina.
authors.forename: R Caresse
authors.initials: RC
authors.lastname: Hightower
authors.affiliation: a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina.|b Wake Forest School of Medicine , Winston-Salem , North Carolina.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Lynch
authors.affiliation: d Wake Forest School of Medicine, Orthopaedic Surgery , Winston-Salem , North Carolina.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Miller
authors.affiliation: a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina.|b Wake Forest School of Medicine , Winston-Salem , North Carolina.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Stitzel
mesh_terms: D015502:Absorptiometry, Photon; D000063:Accidents, Traffic; D017677:Age Distribution; D000368:Aged; D015519:Bone Density; D002138:Calibration; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: ImageJ; bone quality; computed tomography; injury; osteopenia; phantomless; trauma