Role of Dual Energy X-ray Absorptiometry (DEXA) Scan in the Diagnosis of Chronic Low Back Pain - a Prospective Randomized Controlled Study in Osteoporotic Patients Hospitalized in a Tertiary Care Institute

Different cervical vertebral bone quality scores for bone mineral density assessment for the patients with cervical degenerative disease undergoing ACCF/ACDF: computed tomography and magnetic resonance imaging-based study

BACKGROUND

Bone mineral density (BMD) is important for the outcome of cervical spine surgery. As the gold standard of assessing BMD, dual-energy X-ray absorptiometry scans are often not ordered or go unreviewed in patients' charts. As the supplement, MRI-based vertebral bone quality (VBQ) was found to accurately predict osteopenia/osteoporosis and postoperative complications in lumbar spine. However, discussion of the efficiency of VBQ in cervical spine is lacking. And measurement methods of VBQ in cervical spine are diverse and not universally acknowledged like lumbar spine. We aimed to compare the predictive performance of three kinds of different Cervical-VBQ (C-VBQ) scores for bone mineral density assessment in patients undergoing cervical spine surgery. HU value of cervical spine was set as a reference.

METHODS

Adult patients receiving cervical spine surgery for degenerative diseases were retrospectively included between Jan 2015 and Dec 2022 in our hospital. The VBQ scores and HU value were measured from preoperative MRI and CT. The correlation between HU value/C-VBQs (named C-VBQ1/2/3 according to different calculating methods) and DEXA T-score was analyzed using univariate linear correlation and Pearson's correlation. We evaluated the predictive performance of those two parameters and achieved the most appropriate cutoff value by comparing the receiver operating characteristic (ROC) curves.

RESULTS

106 patients (34 patients with T ≥ - 1.0 vs 72 patients with T < - 1.0) were included (mean age: 51.95 ± 10.94, 48 men). According to Pearson correlation analysis, C-VBQ1/2/3 and HU value were all significantly correlated to DEXA T-score (Correlation Coefficient (r): C-VBQ1: - 0.393, C-VBQ2: - 0.368, C-VBQ3: - 0.395, HU value: 0.417, p < 0.001). The area under the ROC curve (AUC) was calculated (C-VBQ1: 0.717, C-VBQ2: 0.717, C-VBQ3: 0.727, HU value: 0.746). The AUC of the combination of C-VBQ3 and HU value was 0.786. At last, the most appropriate cutoff value was determined (C-VBQ1: 3.175, C-VBQ2: 3.005, C-VBQ3: 2.99, HU value: 299.85 HU).

CONCLUSIONS

Different MRI-based C-VBQ scores could all be potential and alternative tools for opportunistically screening patients with osteopenia and osteoporosis before cervical spine surgery. Among them, C-VBQ calculated in ASIC2-C7/SIT1-CSF performed better. We advised patients with C-VBQ higher than cutoff value to accept further BMD examination.

Challenges in Utilization of Osteoporosis Healthcare Services during COVID-19 Pandemic in Romania - a Nationwide Population Study

Objectives: This study compares the utilization of osteoporosis and osteoporosis complication healthcare services before and during the COVID-19 pandemic in Romania. Methods:The descriptive nationwide population study has used secondary data collected from the national health information system. We have calculated and compared the procedures performed for osteoporosis diagnosis and screening, standardized incidence and hospitalization rate for osteoporosis and osteoporosis fractures before and during the COVID-19 pandemic. Results:A 37.84% reduction in the number of DXA scans performed in 2020 have been observed, decreasing from 30,698 in 2019 to 12,064 in 2020. The standardized incidence for osteoporosis was 212.97 cases/100.000 person-years in 2018, 234 cases/100,000 person-years in 2019, and 185.97 cases/100,000 person-years in 2020. The hospitalization rates for osteoporosis have decreased by 68% compared with 2019 and the continuous hospitalization rate for osteoporotic fracture by 48% compared with 2019. Conclusions:The COVID-19 pandemic affected the utilization of healthcare services for osteoporosis management, posing a threat due to a magnified effect on osteoporotic fracture burden. More efforts are further needed to progress and re-engage with osteoporotic fracture prevention in our country and to develop and shape an optimal implementation of prevention and management strategies for all level of health care in Romania.