Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?

Arvind G. Kulkarni, MS; Yeshwanth Thonangi, MS; Sharukh Pathan, MS; Sharvari Gunjotikar, MS; Praveen Goparaju, MS; Inder Talwar, MD; Sunila Jaggi, MD; Sonali Shah, MD; Neha Shah, MD; Girish Kursija, DMRD


Spine. 2022;47(6):E258-E264. 

In This Article

Materials and Methods

After getting approval from the institutional review board (IRB), a total of 718 women presenting to the clinic that were not on anti-osteoporotic treatment regimens were evaluated during the period January 2018 to December 2020 for BMD measurement as a part of screening for osteoporosis in post-menopausal women. Other exclusion criteria included patients with spinal tumors, rheumatoid arthritis, seronegative spondyloarthropathies, multiple myeloma, metastases, endocrinopathies, and connective tissue disorders. Evaluation was done at two different health centers equipped with DXA and Q-CT scanners: 337 Q-CT done at one center, 110 Q-CT, and 271 DXA done at the other. They were randomly assigned to one of the two most popular modalities: Q-CT and DXA. The DXA T-scores were calculated from spine (AP, lumbar vertebrae), bilateral neck of femur and distal one-third of the radius. The diagnostic criteria recommended by the WHO in 1994 was used to establish the diagnosis of osteoporosis. The Q-CT bone mineral density was calculated from L1 to L4 vertebrae from the elliptical regions of interest selected from mid-body axial plane of each vertebra. T-scores were obtained for the Q-CT bone mineral densities and were compared with that of DXA study cohort.

Comparison studies of the T-scores of the bone densities obtained from the two study groups—age-matched, sex—matched and common skeletal site of interest (lumbar vertebrae) were done. To further improve the statistical significance, the screening modalities under study were randomly assigned. Mann–Whitney U test was applied for the comparison of T-scores. Correlation and regression analyses were done. Bell curves were plotted to study the normal distribution of the ages and the T-scores of the study groups.