ArticleJournal of orthopaedic surgery and research2026
Which vertebral levels provide practical HU-based assessment for osteoporosis screening? A comparative analysis from T1 to S2.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo identify practical vertebral HU measurement strategies for opportunistic bone mineral density (BMD) screening using routine CT.
methodsSeven anatomical segmental combinations were defined: upper thoracic (T1-T4, UT), mid-thoracic (T5-T8, MT), lower thoracic (T9-T12, LT), thoracolumbar (T11-L2, TL), upper lumbar (L1-L2, UL), lower lumbar (L3-L5, LL), and sacral (S1-S2, SA). Correlations between HU and DEXA-derived T-score were analyzed for both single vertebrae and multi-segment combinations, using the full-segment average (T1-S2, TS) as reference. Stepwise linear regression across 19 vertebrae generated an exploratory combination (EC) model. ROC analysis and age-sex subgroup analyses were performed.
resultsA total of 300 patients were enrolled (150 males, 150 females; mean age 54.94 ± 14.39 years). Both single- and multi-segment measurements correlated positively with T-score. TS showed the strongest correlation (r = 0.799) and highest predictive performance (AUC = 0.914). Among single vertebrae, T5 showed the strongest correlation (r = 0.785). Among anatomical combinations, TL showed one of the strongest correlations (r = 0.787) and favorable predictive performance (AUC = 0.912). Subgroup analyses showed stable TL performance across sex groups, whereas the strongest correlation and predictive performance were observed in the 51-60-year age subgroup.
conclusionBoth single- and multi-segment HU measurements were effective for BMD assessment. The TL segment represents a practical HU-based assessment approach for opportunistic osteoporosis screening on routine CT, with stable predictive performance and practical clinical value.
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