Evidence map›Paper›PMID 36735159›Full record

ArticleSpine deformity2023

Discrepancy between DXA and CT-based assessment of spine bone mineral density.

Samuel Davidson, Alison Vecellio, Ilexa Flagstad, Kenneth Holton, Angela Bruzina, Paul Lender, Susanne Trost, David Polly

Abstract read
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In one paragraph

Article in Spine deformity, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 4 pooled it
–field-weighted citation impact
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

12 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Review
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  7. Article
  8. Personalized Approaches to Spine Surgery.International journal of spine surgery · 2024
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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

8 authors.

Samuel DavidsonThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA. david958@umn.edu.
Alison VecellioThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
Ilexa FlagstadThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
Kenneth HoltonThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
Angela BruzinaThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
Paul LenderThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
Susanne TrostThe Department of Medicine, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
David PollyThe Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.ORCID 0000-0001-7572-6584

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAdequate bone mineral density (BMD) is necessary for success in spine surgery. Dual-energy X-ray absorptiometry (DXA) is the gold standard in determining BMD but may give spuriously high values. Hounsfield units (HU) from computed tomography (CT) may provide a more accurate depiction of the focal BMD encountered during spine surgery. Our objective is to determine the discrepancy rate between DXA and CT BMD determinations and how often DXA overestimates BMD compared to CT.

methodsWe retrospectively reviewed 93 patients with both DXA and CT within 6 months. DXA lumbar spine and overall T scores were classified as osteoporotic (T Score  ≤ - 2.5) or non-osteoporotic (T Score > -2.5). L1 vertebral body HU were classified as osteoporotic or non-osteoporotic using cutoff thresholds of either ≤ 135 HU or ≤ 110 HU. Corresponding DXA and HU classifications were compared to determine disagreement and overestimation rates.

resultsUsing lumbar T scores, the CT vs DXA disagreement rate was 40-54% depending on the HU threshold. DXA overestimated BMD 97-100% of the time compared to CT. Using overall DXA T scores, the disagreement rate was 33-47% with DXA greater than CT 74-87% of the time. In the sub-cohort of 10 patients with very low HU (HU < 80), DXA overestimated BMD compared to CT in every instance.

conclusionsThere is a large discrepancy between DXA and CT BMD determinations. DXA frequently overestimates regional BMD encountered during spine surgery compared with CT. While DXA remains the gold standard in determining BMD, CT may play an important role in defining the focal BMD pertinent to spine surgery.

Indexed as

Bone DensityOsteoporosisAbsorptiometry, PhotonHumansRetrospective StudiesTomography, X-Ray ComputedBone mineral density (BMD)Computed tomography (CT)Dual-energy X-ray absorptiometry (DXA)

Identifiers

PMID36735159

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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.