Osteoporosis is a common and underdiagnosed chronic metabolic disease1. Opportunistic screening for osteoporosis has been evaluated in several studies, with most focusing on correlation between lumbar vertebrae Hounsfield unit (HU) densities from computed tomography (CT) and T-scores from dual-energy X-ray absorptiometry (DEXA).2 One study of 899 patients evaluated an approach using skull HU densities on CT brain studies with promising results.3 However, a smaller study of 136 patients failed to produce similar significant results.4 It is an attractive prospect to use such a commonly performed...

Retrospective cohort study. 432 patients were identified who had undergone a non-contrast CT brain between January 2016 and December 2017 at The Austin Hospital, and underwent a DEXA bone density scan within the following 12 months. 177 patients who had undergone a bone density scan preceding their CT brain were excluded, so as not to bias the cohort to those with known osteoporosis and to exclude patients on treatment for osteoporosis. The same process was undertaken in a second cohort who underwent non-contrast CT brain...

Of the 327 subjects included, 206 were female and 121 were male. The mean age was 68.7 years (range 21–96 years) and the mean body mass index was 28.5. No significant difference was demonstrated between the Austin and Eastern cohorts in terms of skull density, age or BMI, however, there was a significant difference in femoral neck T-score between the two cohorts (-1.566 vs -1.107, p=0.001). There was a statistically significant difference between the mean skull density (HU) of subjects with normal bone mineral density,...

There is a correlation between skull HU density on CT brain and bone density measured at DEXA, which shows promise in opportunistic screening for osteoporosis. Further work is required to determine a clinically useful skull density threshold to be used as a marker for osteoporosis in our population.

Watts JJ, Abimanyi-Ochom J, Sanders KM. Osteoporosis costing all Australians: A new burden of disease analysis – 2012 to 2022 . (2013). Available at https://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM. Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. JBJS. 2017 Sep 20;99(18):1580-90. Na MK, Won YD, Kim CH, Kim JM, Cheong JH, Ryu JI, Han MH. Opportunistic osteoporosis screening via the measurement of frontal skull Hounsfield units derived from brain computed tomography...