medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.medvis-148Research ArticleКОСТИ И СУСТАВЫBONES AND JOINTSПрогностическая значимость костной плотности, определенной при компьютерной томографии, в отношении низкоэнергетических переломов позвоночникаThe Prognostic Value of Bone Density Measured in Hounsfield Units in Relation to Low Energy Vertebra Fracture PredictionБоковАндрей ЕвгеньевичBokovAndrey Evgenievichnniito@rambler.ruМлявыхСергей ГеннадьевичMlyavykhSergey Gennadievichnoemail@neicon.ruАлейникАлександр ЯковлевичAleynikAlexander Yakovlevichnoemail@neicon.ruРастеряеваМарина ВячеславовнаRasteryaevaMarina Vyacheslavovnanoemail@neicon.ruКутлаеваМарина АлександровнаKutlaevaMarina Alexandrovnanoemail@neicon.ruФГБУ “Приволжский федеральный медицинский исследовательский центр” Минздрава РоссииРоссияPrivolzhsky Federal Research CenterRussian Federation201528062015039498Copyright © Боков А.Е., Млявых С.Г., Алейник А.Я., Растеряева М.В., Кутлаева М.А., 20152015Боков А.Е., Млявых С.Г., Алейник А.Я., Растеряева М.В., Кутлаева М.А.Bokov A.E., Mlyavykh S.G., Aleynik A.Y., Rasteryaeva M.V., Kutlaeva M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/148

При выполнении рентгеновской КТ может быть определена костная плотность в единицах Хаунсфилда (ед.Н), но прогностическая значимость этого параметра в отношении низкоэнергетических переломов позвонков до настоящего времени недостаточно исследована. Цель исследования: определить прогностическую значимость костной плотности, определенной при КТ-исследовании, в отношении риска низкоэнергетических патологических переломов. Материал и методы. Проведена оценка результатов КТ 100 пациентов. На уровне LII или LIII определяли плотность губчатой кости в ед.Н в сагиттальной, фронтальной плоскостях и на аксиальных срезах, после чего вычисляли среднее значение. Регистрировали наблюдения с одно- и многоуровневыми патологическими переломами, а также наблюдения с многоуровневыми дегенеративными изменениями. Исследовали прогностическую значимость указанных параметров в отношении патологических компрессионных переломов позвонков, для этого применяли логистический регрессионный анализ. Результаты. Выявлено, что имеется связь плотности позвонков, определенной в ед.Н, с частотой патологических переломов: снижение костной плотности ниже 101 ед.Н сопряжено с нарастанием частоты патологических переломов, в то время как снижение костной плотности ниже 82 ед.Н ассоциируется с увеличением частоты многоуровневых патологических переломов. Наличие многоуровневых дегенеративных изменений ассоциируются со снижением частоты патологических переломов позвонков. Заключение. КТ-данные могут быть использованы для оценки риска патологических компрессионных переломов позвонков и служить основанием для назначения профилактических мер или дальнейшего обследования.

Computed tomography (CT) can be used to accurately determine bone density in Hounsfield units (HU), the use of CT as a predictive tool has not been conclusively demonstrated in relation to low energy vertebra compression fracture (VCF). The objective: to define the prognostic value of bone density measured during CT investigation in relation to VCF. Materials and methods. One hundred consecutive patients undergoing CT scans were enrolled in this study. Bone density measurements were obtained at the level LII or LIII from the cancellous portion of the vertebral body in the mid-sagittal, mid-coronal and axial planes. The presence of a single-level or multi-level VCF was identified by CT. Multilevel degenerative changes were characterized and recorded. Logistic regression was utilized to assess the relationship between the variables of bone density in HU, single - or multi-level VCF and the presence of degenerative changes. Results. HU were found to have a strong correlation to the risk of VCF. HU of less than 101 were associated with a significant increase in the rate of VCF, whereas HU of less than 82 were associated with a significant increase in the rate of multi-level VCF. Hypertrophic degenerative changes were found to be associated with a decreased rate of VCF. Conclusion. CT data can accurately define the risk of VCF and therefore presents a useful clinical tool to support the need for prophylactic medical therapies for osteoporosis or to provide information useful in counseling patients at risk for VCF.

компьютерная томографиякостная плотностьединицы Хаунсфилдапатологические компрессионные переломы позвонковimputed tomographyBone densityHounsfield unitsVertebral compression fractureReferencesFelsenberg D., Silman A.J., Lunt M. et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J. Bone Miner Res. 2002; 17: 716-724.Felsenberg D., Silman A.J., Lunt M. et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J. Bone Miner Res. 2002; 17: 716-724.Johnell O., Kanis J. Epidemiology of osteoporotic fractures. Osteoporosis Int. 2005; 16: S3-S7.Johnell O., Kanis J. Epidemiology of osteoporotic fractures. Osteoporosis Int. 2005; 16: S3-S7.Hodsman A.B., Leslie W.D., Tsang J.F. et al. 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program. Arch. Intern. Med. 2008; 168: 2261-2267.Hodsman A.B., Leslie W.D., Tsang J.F. et al. 10-year probability of recurrent fractures following wrist and other osteoporotic fractures in a large clinical cohort: an analysis from the Manitoba Bone Density Program. Arch. Intern. Med. 2008; 168: 2261-2267.LaFleur J., McAdam-Marx C., Kirkness C. et al. Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature. Ann. Pharmacolther. 2008; 42: 375-386.LaFleur J., McAdam-Marx C., Kirkness C. et al. Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature. Ann. Pharmacolther. 2008; 42: 375-386.McLeod K.M., Johnson C.S. Identifying women with low bone mass: a systematic review of screening tools. Geriatr Nurse. 2009; 30: 164-173.McLeod K.M., Johnson C.S. Identifying women with low bone mass: a systematic review of screening tools. Geriatr Nurse. 2009; 30: 164-173.Schlaich C., Minne H.W., Bruckner T. et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis Int. 1998; 8: 261-267.Schlaich C., Minne H.W., Bruckner T. et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis Int. 1998; 8: 261-267.Pluijm S.M., Tromp A.M., Smit J.H. et al. Consequences of vertebral deformities in older men and women. J. Bone Miner. Res. 2000; 15: 1564-1572.Pluijm S.M., Tromp A.M., Smit J.H. et al. Consequences of vertebral deformities in older men and women. J. Bone Miner. Res. 2000; 15: 1564-1572.Black D.M., Steinbuch M., Palermo L. et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporosis Int. 2001; 12: 519-528.Black D.M., Steinbuch M., Palermo L. et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporosis Int. 2001; 12: 519-528.Kanis J.A., Johnell O., Oden A. et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis Int. 2008; 19: 385-397.Kanis J.A., Johnell O., Oden A. et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis Int. 2008; 19: 385-397.Yi Y., Hwang B., Son H. et al. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician. 2012; 15: 441-449.Yi Y., Hwang B., Son H. et al. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician. 2012; 15: 441-449.Mull R.T. Mass estimates by computed tomography: physical density from CT numbers. Am. J. Roentgenol. 1984; 143: 1101-1104.Mull R.T. Mass estimates by computed tomography: physical density from CT numbers. Am. J. Roentgenol. 1984; 143: 1101-1104.Naganathan V., Jones G., Nash P. et al. Vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteroid use. Arch. Intern. Med. 2000; 160: 2917-2922.Naganathan V., Jones G., Nash P. et al. Vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteroid use. Arch. Intern. Med. 2000; 160: 2917-2922.Rehman Q., Lang T., Modin G. et al. Quantitative computed tomography of the lumbar spine, not dual X-Ray absorptiometry, is an independent predictor of prevalent vertebral fractures in postmenopausal women with osteopenia receiving long-term glucocorticoid and hormone-replacement therapy. Arthr. Rheum. 2002; 46: 1292-1297.Rehman Q., Lang T., Modin G. et al. Quantitative computed tomography of the lumbar spine, not dual X-Ray absorptiometry, is an independent predictor of prevalent vertebral fractures in postmenopausal women with osteopenia receiving long-term glucocorticoid and hormone-replacement therapy. Arthr. Rheum. 2002; 46: 1292-1297.Merheb J., Van Assche N., Coucke W. et al. Relationship between cortical bone thickness or computerized tomography-derived bone density values and implant stability. Clin. Oral. Implants Res. 2010; 21: 612-617.Merheb J., Van Assche N., Coucke W. et al. Relationship between cortical bone thickness or computerized tomography-derived bone density values and implant stability. Clin. Oral. Implants Res. 2010; 21: 612-617.Hiasa K., Abe Y., Okazaki Y. et al. Preoperative computed tomography-derived bone densities in Hounsfield units at implant sites acquired primary stability. ISRN Dent. 2011; 2011: 678-729.Hiasa K., Abe Y., Okazaki Y. et al. Preoperative computed tomography-derived bone densities in Hounsfield units at implant sites acquired primary stability. ISRN Dent. 2011; 2011: 678-729.Pickhardt P.J., Lee L.J., del Rio A.M. et al. Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J. Bone Miner. Res. 2011; 26: 2194-2203.Pickhardt P.J., Lee L.J., del Rio A.M. et al. Simultaneous screening for osteoporosis at CT colonography: bone mineral density assessment using MDCT attenuation techniques compared with the DXA reference standard. J. Bone Miner. Res. 2011; 26: 2194-2203.Genant H.K., Wu C.Y., Vankuijk C.,et al. Vertebral fracture assessment using a semiquantitative technique. J. Bone Miner. Res. 1993; 8: 1137-1148.Genant H.K., Wu C.Y., Vankuijk C.,et al. Vertebral fracture assessment using a semiquantitative technique. J. Bone Miner. Res. 1993; 8: 1137-1148.Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br. Med. J. 1996; 312: 1254-1259.Marshall D., Johnell O., Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br. Med. J. 1996; 312: 1254-1259.Bouxsein M.L., Palermo L., Yeung C. et al. Digital X-ray radiogrammetry predicts hip, wrist and vertebral fracture risks in elderly women. A prospective analysis from the study of osteoporotic fractures. Osteoporosis Int. 2002; 13: 358-365.Bouxsein M.L., Palermo L., Yeung C. et al. Digital X-ray radiogrammetry predicts hip, wrist and vertebral fracture risks in elderly women. A prospective analysis from the study of osteoporotic fractures. Osteoporosis Int. 2002; 13: 358-365.Lewis C.E., Ewing S.K., Taylor B.C. et al. Predictors of non-spine fracture in elderly men: the MrOS study. J. Bone Miner. Res. 2007; 22: 211-219.Lewis C.E., Ewing S.K., Taylor B.C. et al. Predictors of non-spine fracture in elderly men: the MrOS study. J. Bone Miner. Res. 2007; 22: 211-219.Small R.E. Uses and Limitations of Bone Mineral Density Measurements in the Management of Osteoporosis. Med. Gen. Med. 2005; 7: 3.Small R.E. Uses and Limitations of Bone Mineral Density Measurements in the Management of Osteoporosis. Med. Gen. Med. 2005; 7: 3.Lewiecki E.M., Laster A.J. Clinical review: clinical applications of vertebral fracture assessment by dualenergy X-ray absorptiometry. J. Clin. Endocrinol. Metab. 2006; 91: 4215-4222.Lewiecki E.M., Laster A.J. Clinical review: clinical applications of vertebral fracture assessment by dualenergy X-ray absorptiometry. J. Clin. Endocrinol. Metab. 2006; 91: 4215-4222.Vokes T.J., Gillen D.L. Using clinical risk factors and bone mineral density to determine who among patients undergoing bone densitometry should have vertebral fracture assessment. Osteoporosis Int. 2010; 21: 2083-2091.Vokes T.J., Gillen D.L. Using clinical risk factors and bone mineral density to determine who among patients undergoing bone densitometry should have vertebral fracture assessment. Osteoporosis Int. 2010; 21: 2083-2091.Xu W., Perera S., Medich D. et al. Height Loss, Vertebral Fractures, and the Misclassification of Osteoporosis. Bone. 2011; 48: 307-311.Xu W., Perera S., Medich D. et al. Height Loss, Vertebral Fractures, and the Misclassification of Osteoporosis. Bone. 2011; 48: 307-311.Tenne M., McGuigan F., Besjakov J. et al. Degenerative changes at the lumbar spine-implications for bone mineral density measurement in elderly women. Osteoporosis Int. 2013; 24: 1419-1428.Tenne M., McGuigan F., Besjakov J. et al. Degenerative changes at the lumbar spine-implications for bone mineral density measurement in elderly women. Osteoporosis Int. 2013; 24: 1419-1428.Liu G., Peacock M., Eilam O., et al. Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporosis Int. 1997; 7: 564-569.Liu G., Peacock M., Eilam O., et al. Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporosis Int. 1997; 7: 564-569.Абдрахманова Ж.С. Костная денситометрия и компьютерная томография в оценке пороговых значений минеральной плотности тел позвонков как фактор риска их переломов: Автореф. дис.. канд. мед. наук. Томск, 2006. 19 c.Абдрахманова Ж.С. Костная денситометрия и компьютерная томография в оценке пороговых значений минеральной плотности тел позвонков как фактор риска их переломов: Автореф. дис.. канд. мед. наук. Томск, 2006. 19 c.Pollintine P., Dolan P., Tobias J.H. et al. Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine. 2004; 29: 774-782.Pollintine P., Dolan P., Tobias J.H. et al. Intervertebral disc degeneration can lead to “stress-shielding” of the anterior vertebral body: a cause of osteoporotic vertebral fracture? Spine. 2004; 29: 774-782.

The authors declare that there are no conflicts of interest present.