Computed Tomography-Based L1 Bone Mineral Density in 624 Dutch Trauma Patients-Are North American Reference Values Valid in Europe?

Abstract

Opportunistic screening for bone mineral density (BMD) of the first lumbar vertebra (L1) using computed tomography (CT) is increasingly used to identify patients at risk for osteoporosis. An extensive study in the United States has reported sex-specific normative values of CT-based BMD across all ages. The current study aims to validate North American reference values of CT-based bone mineral density in a Dutch population of level-1 trauma patients. All trauma patients aged 16 or older, admitted to our level-1 trauma center during 2017, who underwent a CT scan of the chest or abdomen at 120 kVp within 7 days of hospital admission, were retrospectively included. BMD measurements in Hounsfield Units (HU) were performed manually in L1 or an adjacent vertebra. Student's t-tests were performed to compare the Dutch mean BMD value per age group to the North American reference values. Linear regression analysis and Pearson's correlation coefficient (ρ) calculations were performed to assess the correlation between BMD and age. In total, 624 patients were included (68.4% men, aged 16-95). Mean BMD decreased linearly with 2.4 HU per year of age (ρ = -0.77). Sex-specific analysis showed that BMD of premenopausal women was higher than BMD of men at these ages. Dutch mean BMD values in the age groups over 35 years were significantly lower than the North American reference values. Our findings indicate that using North American BMD thresholds in Dutch clinical practice would result in overdiagnosis of osteoporosis and osteopenia. Dutch guidelines may benefit from population-specific thresholds.