Cardiac CT can double as osteoporosis test

July 14, 2020

OAK BROOK, Ill. - Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a study published in Radiology.

Osteoporosis is a disease that causes the bones to weaken and become vulnerable to fracture. It affects an estimated 200 million people worldwide. Early detection and treatment are important, as several classes of drugs are effective at reducing the risk of fractures that exact a devasting toll on victims. A National Osteoporosis Foundation report last year found that nearly 20 percent of Medicare fee-for-service beneficiaries died within 12 months of a new osteoporotic fracture.

Bone mineral density (BMD) tests can diagnose osteoporosis, but the number of people who get these tests is suboptimal.

"Osteoporosis is a prevalent, under-diagnosed and treatable disease associated with increased morbidity and mortality," said study lead author Josephine Therkildsen, M.D., from Herning Hospital, Hospital Unit West, in Herning, Denmark. "Effective anti-osteoporotic treatment exists and so, identifying individuals with greater fracture rate who may benefit from such treatment is imperative."

Dr. Therkildsen and colleagues recently looked at cardiac CT, a test done to assess heart health, as an opportunistic way to screen for osteoporosis. Because the cardiac CT scan also visualizes the thoracic vertebrae, the bones that form the vertebral spine in the upper trunk, it is relatively easy to add a BMD test to the procedure.

The study involved 1,487 participants who underwent cardiac CT for evaluation of heart disease. Participants also had BMD testing of three thoracic vertebrae using quantitative CT software.

Of the 1,487 people in the study, 179, or 12%, had very low BMD. During follow-up of just over three years on average, 80 of the participants, or 5.3%, were diagnosed with a fracture. The fracture was osteoporosis-related in 31 of the 80 people.

The association between a very low BMD and a higher rate of fracture strongly suggests that thoracic spine BMD may be used to guide osteoporosis preventive measures and treatment decisions, the study authors said.

Adding BMD testing to cardiac CT is feasible and applicable in a clinical setting, according to Dr. Therkildsen. It does not add time to the exam and doesn't expose the patient to any additional radiation. In fact, Dr. Therkildsen said, technological advances over time have reduced the radiation dose given at cardiac CT. BMD measurements can be made using existing non-enhanced CT images as long as a suitable calibration system is ensured, scanner stability is continuously monitored and systematic imaging acquisition techniques are implemented.

"We believe that opportunistic BMD testing using routine CT scans can be done with little change to normal clinical practice and with the benefit of identifying individuals with a greater fracture rate," Dr. Therkildsen said.

Although the researchers used cardiac CT images in the study, in theory any CT images that include a view of relevant bone structures could be used for measuring BMD. The development of fully automated software for BMD measurements further enhances the adaptability and convenience of this approach.

Additional research will help pin down the optimal BMD cut-off values for treatment while providing more data on fracture risk based on gender and areas of the body. The impact of clinical risk factors in combination with BMD measured from CT scans for the assessment of fracture risk would also benefit further study.

"Our research group is dedicated to extend the research in this field, as we believe it should be added to clinical practice," Dr. Therkildsen said.
"Thoracic Bone Mineral Density Derived from Cardiac CT Is Associated with Greater Fracture Rate." Collaborating with Dr. Therkildsen were Louise Nissen, M.D., Ph.D., Hanne S. Jørgensen, M.D., Ph.D., Jesper Thygesen, M.Sc., Per Ivarsen, M.D., Ph.D., Lars Frost, M.D., Ph.D., D.M.Sc., Christin Isaksen, M.D., Bente L. Langdahl, M.D., Ph.D., D.M.Sc., Ellen-Margrethe Hauge, M.D., Ph.D., Morten Boettcher, M.D., Ph.D., and Simon Winther, M.D., Ph.D.

Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, and owned and published by the Radiological Society of North America, Inc. (

RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (

Radiological Society of North America

Related Osteoporosis Articles from Brightsurf:

New opportunities for detecting osteoporosis
Osteoporosis can be detected through low dose computed tomography (LDCT) imaging tests performed for lung cancer screening or other purposes.

Oxytocin can help prevent osteoporosis
In a laboratory experiment with rats, Brazilian researchers succeeded in reversing natural processes associated with aging that lead to loss of bone density and strength.

New strategy against osteoporosis
An international research team has found a new approach that may be able to reduce bone loss in osteoporosis and maintain bone health.

New review on management of osteoporosis in premenopausal women
An IOF and ECTS Working Group have published an updated review of literature published after 2017 on premenopausal osteoporosis.

Cardiac CT can double as osteoporosis test
Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a new study.

Osteoporosis treatment may also protect against pneumonia
A recent study published in the Journal of Bone and Mineral Research found that nitrogen-containing bisphosphonates (N-BPs) such as alendronate, which are widely used to treat postmenopausal osteoporosis, are linked with lower risks of pneumonia and of dying from pneumonia.

New pharmaceutical target reverses osteoporosis in mice
Biomedical engineers at Duke University have discovered that an adenosine receptor called A2B can be pharmaceutically activated to reverse bone degradation caused by osteoporosis in mouse models of the disease.

A link between mitochondrial damage and osteoporosis
In healthy people, a tightly controlled process balances out the activity of osteoblasts, which build bone, and osteoclasts, which break it down.

Many stroke patients not screened for osteoporosis, despite known risks
Many stroke survivors have an increased risk of osteoporosis, falls or breaks when compared to healthy people.

Many postmenopausal women do not receive treatment for osteoporosis
The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued today by the Endocrine Society.

Read More: Osteoporosis News and Osteoporosis Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to