ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Assessing bone quality in hounsfield units using computed tomography: what value should be used to classify bone as normal or osteoporotic?
Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Prediction of axillary lymph node metastasis in breast cancer using preoperative CT Hounsfield units: A retrospective study.Medicine · 2026Article
- Multilevel Lumbar CT Attenuation Beyond L1: Comparison with QCT-Derived Volumetric Bone Mineral Density and Prevalent Fragility Fracture Status in a Diagnostic Referral Cohort.Diagnostics (Basel, Switzerland) · 2026Article
- Opportunistic CT assessment of psoas muscle attenuation and its association with lumbar osteoporosis in total hip arthroplasty candidates.Skeletal radiology · 2026Article
- Giant Retroperitoneal Lumbar Schwannoma with Extensive Vertebral Body Erosion Managed Without Spinal Instrumentation: The Potential Role of Hounsfield Unit Assessment in Surgical Decision-Making.Journal of clinical medicine · 2026Article
- Comprehensive evaluation of a deep learning-based synthetic CT model for MR-only radiotherapy across multiple anatomical sites.Physics and imaging in radiation oncology · 2026Article
- BMI-stratified performance of native CT hounsfield units in the proximal femur for osteoporosis detection and fracture association.BMC musculoskeletal disorders · 2026Article
- [Trabecular bone density measurement in Hounsfield units in the proximal femur for osteoporosis assessment and fracture risk determination].Orthopadie (Heidelberg, Germany) · 2026Article
- Cross-Sectional Clinical Evaluation of Subantral Augmentation Using Nano Graft Composite: Implications for Implant Success.Dentistry journal · 2026Article
- Usage of Hounsffeld unit to differentiate idiopathic condylar resorption: a preliminary study.Journal of oral & facial pain and headache · 2026Article
- Clinical and radiological predictors of adverse outcomes after unilateral biportal endoscopic surgery for short-segment degenerative lumbar spinal stenosis.Frontiers in surgery · 2026Article
- Sensitivity analysis of key CT simulation parameters and their impact on quality of virtual images.Medical physics · 2025Article
- Development and internal validation of a clinical-radiological nomogram for osteoporosis screening: A cohort retrospective study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- An improved method for measuring the hounsfield units of the vertebral body and pedicles in patients with lumbar degenerative diseases.Neurosurgical review · 2025Article
- CT-Based Evaluation of Bone Mineral Density Distribution of Proximal Femur in Patients With Femoral Trochanteric Fracture.Geriatric orthopaedic surgery & rehabilitation · 2025Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of this study was to investigate threshold values for classifying bone as normal or osteoporotic based on Computed Tomography (CT) Hounsfield Units (HU) and to determine if clinically applicable values could be derived to aid spine surgeons evaluating bone quality using CT.
methodsThis literature review was completed using PubMed and Ovid (MedLine), using syntax specific to bone quality and CT. The included articles were original clinical studies assessing bone quality and utilized composite L1-L4 HU values compared against dual-energy X-ray absorptiometry (DEXA) values. Extracted data study descriptors, CT measurement technique, and CT threshold values. CTs were measured from L1-L4 using either axial or sagittal images, and must classify their bone quality findings for any of the following 3 categories: normal, osteopenia, or osteoporosis.
resultsThis review located 34 studies measuring bone density using CT with threshold values, of which, 10 were included in the final review. Number of patients ranged from 74 to 283 and cohort ages from 20s to 70.6 years. CT threshold values for assessing normal and osteoporotic bone quality ranged from 150 to 179 and 87 to 155, respectively. From combining values across studies, a HU value of ≥ 170 HU was associated with normal bone and ≤ 115 HU with osteoporosis.
conclusionThere is variation in HU values used to differentiate normal from compromised bone quality, even after limiting studies. For patients with HU values between or near 170 or 115 HU, a DEXA scan may be warranted for further evaluation. With ongoing investigation in this area, threshold values for classifying bone quality using CT will be continually refined.
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Registered trials
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