Abdominal computed tomography (CT) scans obtained for other reasons can be used for osteoporosis screening, according to an article published in the April 16 issue of the Annals of Internal Medicine.
Central dual-energy X-ray absorptiometry (DXA) of the hips and lumbar spine is widely recognized as the reference standard for diagnosing osteoporosis, yet the procedure is underutilized, according to the article's authors from the University of Wisconsin School of Medicine and Public Health.
The paper was authored by Perry J. Pickhardt, MD; B. Dustin Pooler, MD; Travis Lauder, BS; Alejandro Muñoz del Rio, PhD; Richard J. Bruce, MD; and Neil Binkley, MD. The National Institutes of Health provided primary funding.
Nearly half of all female Medicare beneficiaries have never had a bone mineral density (BMD) test, the authors noted. Recognizing a need for safe and cost-effective alternatives to DXA screening, the researchers sought to determine if CT scans performed for other clinical indications could be used to assess BMD.
Researchers compared CT scans to DXA scans performed within 6 months of the CT for 1,867 patients over a 10-year period. They found that nearly half of patients with an osteoporotic vertebral compression fracture identified by the CT scan had been classified as having normal bone density by the DXA scan. The researchers conclude that CT scans can be used opportunistically to screen for osteoporosis without additional radiation exposure or cost.
However, the authors of an accompanying editorial in the same issue of the publication cautioned against adding more information to CT reports already replete with incidental findings, as only about half of incidental findings are ever acted on or confirmed. The editorial authors suggested that CT reports linked to evidence summaries and actionable reminders that could be transmitted to primary care physicians may be a more effective way to increase the likelihood of follow up and treatment.