Prevalence of osteoporosis in older male veterans receiving hip-containing computed tomography scans: opportunistic use of biomechanical computed tomography analysis (BCT)

Polly F Teng; Janet M Chiang; Anne L Schafer; Preeti A Sukerkar; Tony M Keaveny; Daniel Bikle

doi:10.1007/s00198-022-06624-3

Prevalence of osteoporosis in older male veterans receiving hip-containing computed tomography scans: opportunistic use of biomechanical computed tomography analysis (BCT)

Osteoporos Int. 2023 Mar;34(3):551-561. doi: 10.1007/s00198-022-06624-3. Epub 2022 Dec 29.

Authors

Polly F Teng^#^{1

2}, Janet M Chiang^#^{3

4}, Anne L Schafer^{5

6}, Preeti A Sukerkar⁷, Tony M Keaveny⁸, Daniel Bikle^{5

6}

Affiliations

¹ Divison of Endocrinology, Diabetes and Metabolism, University of California, Davis, USA.
² Department of Orthopedic Surgery, University of California, Davis, USA.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of California, 4150 Clement St., CA, 94121, San Francisco, USA. Janet.chiang@ucsf.edu.
⁴ Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, USA. Janet.chiang@ucsf.edu.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of California, 4150 Clement St., CA, 94121, San Francisco, USA.
⁶ Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, USA.
⁷ Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
⁸ Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, USA.

^# Contributed equally.

Abstract

Osteoporosis care in men is suboptimal due to low rates of testing and treatment. Applying biomechanical computed tomography (BCT) analysis to existing CT scans, we found a high proportion of men with osteoporosis have never been diagnosed or treated. BCT may improve identification of patients at high risk of fracture.

Purpose: Osteoporosis care in men is suboptimal due to low rates of DXA testing and treatment. Biomechanical computed tomography analysis (BCT) can be applied "opportunistically" to prior hip-containing CT scans to measure femoral bone strength and hip BMD.

Methods: In this retrospective, cross-sectional study, we used BCT in male veterans with existing CT scans to investigate the prevalence of osteoporosis, defined by hip BMD (T-score ≤ - 2.5) or fragile bone strength (≤ 3500 N). 577 men, age ≥ 65 with abdominal/pelvic CTs performed in 2017-2019, were randomly selected for BCT analysis. Clinical data were collected via electronic health records and used with the femoral neck BMD T-score from BCT to estimate 10-year hip fracture risks by FRAX.

Results: Prevalence of osteoporosis by BCT increased with age (13.5% age 65-74; 18.2% age 75-84; 34.3% age ≥ 85), with an estimated overall prevalence of 18.3% for men age ≥ 65. In those with osteoporosis (n = 108/577), only 38.0% (41/108) had a prior DXA and 18.6% (7/108) had received osteoporosis pharmacotherapy. Elevated hip fracture risk by FRAX (≥ 3%) did not fully capture those with fragile bone strength. In a multivariate logistic regression model adjusted for age, BMI, race, and CT location, end stage renal disease (odds ratio 7.4; 95% confidence interval 2.3-23.9), COPD (2.2; 1.2-4.0), and high-dose inhaled corticosteroid use (3.7; 1.2-11.8) were associated with increased odds of having osteoporosis by BCT.

Conclusion: Opportunistic BCT in male veterans provides an additional avenue to identify patients who are at high risk of fractures.

Keywords: CT; Fracture risk assessment; Men; Osteoporosis; Screening.

MeSH terms

Absorptiometry, Photon / methods
Aged
Aged, 80 and over
Bone Density
Cross-Sectional Studies
Hip Fractures* / diagnostic imaging
Hip Fractures* / epidemiology
Hip Fractures* / etiology
Humans
Male
Osteoporosis* / complications
Osteoporosis* / diagnostic imaging
Osteoporosis* / epidemiology
Prevalence
Retrospective Studies
Tomography, X-Ray Computed / methods
Veterans*