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Biomechanical CT Compared with DXA Testing

J Bone Miner Res; ePub 2018 Apr 17; Adams, et al

Biomechanical computed tomography (BCT) analysis of previously acquired routine abdominal or pelvic CT scans is at least as effective as dual-energy X-ray absorptiometry (DXA) testing for identifying patients at high risk of hip fracture, according to a recent study. Researchers assessed the efficacy of this BCT approach for identifying patients at high risk of incident hip fracture in a large clinical setting. Using a case‐cohort design sampled from 111,694 women and men, aged ≥65 years, who had a prior hip CT scan, a DXA within 3 years of the CT, and no prior hip fracture, they compared those with subsequent hip fracture (n=1,959) with randomly selected sex‐stratified controls (n=1,979) and analyzed their CT scans blinded to all other data. They found:

  • The age‐, race‐, and body mass index (BMI)‐adjusted hazard ratio (HR) for femoral strength was significant before and after adjusting also for the (lowest) hip bone mineral density (BMD) T‐score by BCT.
  • The HR for the hip BMD T‐score was similar between BCT and DXA for both sexes and was higher than for the (lowest) spine/hip BMD T‐score by DXA.


Adams AL, Fischer H, Kopperdahl DL, et al. Osteoporosis and hip fracture risk from routine computed tomography scans: The Fracture, Osteoporosis, and CT Utilization Study (FOCUS). [Published online ahead of print April 17, 2018]. J Bone Miner Res. doi:10.1002/jbmr.3423.