Evidence map›Paper›PMID 32594205›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2020

Ten-year fracture risk predicted by proximal femur Hounsfield units.

D L Christensen, K E Nappo, J A Wolfe, J G Tropf, M J Berge, B M Wheatley, S Saxena, B G Yow, S M Tintle

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Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
1.4field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. CT Hounsfield Unit Measurements Around the Hip and Their Utility for Opportunistic Screening: A Systematic Review.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026
    Pooled it
  2. CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024
    Pooled it
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  4. Low energy Schatzker IV, V, and VI tibial plateau fractures are a marker of local poor bone quality.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

D L ChristensenDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.ORCID http://orcid.org/0000-0003-2855-4008
K E NappoDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
J A WolfeDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
J G TropfDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
M J BergeDepartment of Radiology, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
B M WheatleyDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
S SaxenaDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
B G YowDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
S M TintleDepartment of Surgery Orthopaedic Service, Walter Reed National Military Medical Center, Uniformed Services University-Walter Reed, 8901 Rockville Pike, Bethesda, MD, 20889, USA. scott.tintle@gmail.com.
Walter Reed National Military Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Colon cancer screening occurs at younger ages than osteoporosis screening. Bone density measurements using virtual colonoscopy performed for colon cancer screening can provide an early warning sign of patients at potential risk for osteoporosis-related fractures. Earlier identification may improve treatment and potentially fracture prevention.

introductionOpportunistic osteoporosis screening with computed tomography colonography (CTC) offers an opportunity to capitalize on earlier colorectal cancer screening to identify patients at risk of future fractures. The purpose of this study is to evaluate 10-year fracture and specifically hip fracture risk based on Hounsfield units (HU) obtained from CTC.

methodsWe identified all CTC scans between 2004 and 2007 of patients 40 years and older with 10 years minimum follow-up. Hounsfield units were measured within the proximal femur and fractures identified via worldwide military records. Patients were stratified into two cohorts based on the presence or lack of a fracture in the wrist, spine, hip, or proximal humerus. Hounsfield unit measurements were compared between groups using Student's t test and the HU threshold was calculated that best approximated an 80% sensitivity to optimally screen patients for fracture risk. The odds ratio, negative predictive value, 10-year incidence of fracture, and survival curves were calculated.

resultsWe identified 3711 patients with 183 fractures over 10 years. The HU threshold that corresponded with an 80% sensitivity to identify fractures was 112 HU. The negative predictive value (NPV) for overall fractures and hip fractures was over 97%. The 10-year fracture incidence was higher in patients below 112 HU compared to those above for both overall fractures (6.3% vs 1.7%) and hip fractures (2.7% vs 0.07%). The 112 HU threshold corresponds with an odds ratio for overall fracture and hip fractures of 2.5 (95% confidence interval (CI), 1.7-3.6) and 24.5 (95% CI, 3.3-175.5), respectively.

conclusionIn the 10 years following CTC, patients who experienced a fracture had lower hip HU. Decreasing HU on CTC may be an early warning sign of fracture potential.

Indexed as

Femoral FracturesOsteoporosisTomography, X-Ray ComputedAbsorptiometry, PhotonBone DensityFemurHumansRisk AssessmentComputed tomography colonoscopyFracture preventionFragility fractureHip fractureOpportunistic screeningOsteoporosisVirtual colonoscopy

Identifiers

PMID32594205
OpenAlexW3037329237

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.