medigraphic.com
SPANISH

Cirugía de Columna

ISSN 2992-7749 (Electronic)
ISSN 2992-7897 (Print)
Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C. y de la Sociedad Iberolatinoamericana de Columna. SILACO.

Indizada en:

Scielo
  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
    • Send manuscript
  • Políticas
    • Objetivos y Alcance
    • Carta de autorización de pacientes
    • Política publicitaria
    • Políticas éticas
    • Políticas de acceso abierto
    • Políticas de revisión de manuscritos
    • Políticas editoriales generales
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2026, Number 4

<< Back Next >>

Cir Columna 2026; 4 (4)

Comparation of the Hounsfield units versus bone densitometry in the diagnosis of osteoporosis

Bazán PL, Cinalli M, Sirna P
Full text How to cite this article 10.35366/123545

DOI

DOI: 10.35366/123545
URL: https://dx.doi.org/10.35366/123545

Language: Spanish
References: 23
Page: 294-297
PDF size: 590.11 Kb.


Key words:

osteoporosis, DXA, Hounsfield units, tomography, fragility.

ABSTRACT

Introduction: osteoporosis is a skeletal disease characterized by alterations in microarchitecture that results in fragility and predisposition to fractures. The diagnostic gold standard is bone densitometry. Many alternatives have been analyzed to assess "bone health", one of them is the measurement of Hounsfield units (HU) in tomography. Objective: to compare the use of HU with DEXA, calculate sensitivity, specificity, positive predictive value and negative predictive value of tomography for osteoporosis diagnosis and evaluate whether these results vary according to the age of patients. Material and methods: a cross-sectional study with patients over 55 years of age, using densitometry and contemporary tomography. Region of Interest (ROI) in R1 axial cut was measured. Results: 54 patients were admitted, with an average age of 70.46 years, with IC95%; 39 had a diagnosis of osteoporosis due to HU and 27 by bone densitometry; in 20 cases no diagnostic correlation was found. HU: 85% sensitivity, 41% specificity, 59% positive predictive value and 73% negative predictive value. The agreement between the two studies was 62.96. The group of over 65 years, sensitivity increased to 90%, specificity was 21%. Conclusions: HU measurement exhibits high sensitivity and low specificity, making it a valuable screening method in existing computed tomography (CT) scans; however, it is not a substitute for bone densitometry. Further large-scale studies are required.


REFERENCES

  1. Alexeeva L, Burkhardt P, Christiansen C, Cooper C, Delmas P, Johnell O, et al. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. World Health Organization - Technical Report Series. 1994; 843: 1-129.

  2. Mazess RB, Barden HS. Measurement of bone by dual-photon absorptiometry (DPA) and dual-energy X-ray absorptiometry (DEXA). Ann Chir Gynaecol. 1988; 77: 197-203.

  3. Hounsfield GN. Computerized transverse axial scanning (tomography): part I. Description of system. 1973. Br J Radiol. 1995; 68: H166-H172.

  4. 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. J Bone Joint Surg Am. 2017; 99: 1580-1590. doi: 10.2106/JBJS.16.00749.

  5. Anderson PA, Polly DW, Binkley NC, Pickhardt PJ. Clinical use of opportunistic computed tomography screening for osteoporosis. J Bone Joint Surg Am. 2018; 100: 2073-2081. doi: 10.2106/JBJS.17.01376.

  6. Schreiber JJ, Anderson PA, Hsu WK. Use of computed tomography for assessing bone mineral density. Neurosurg Focus. 2014; 37: E4. doi: 10.3171/2014.5.FOCUS1483.

  7. Kim KJ, Kim DH, Lee JI, Choi BK, Han IH, Nam KH. Hounsfield units on lumbar computed tomography for predicting regional bone mineral density. Open Med (Wars). 2019; 14: 545-551. doi: 10.1515/med-2019-0061.

  8. Zou D, Li W, Deng C, Du G, Xu N. The use of CT Hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases. Eur Spine J. 2019; 28: 1758-1766. doi: 10.1007/s00586-018-5776-9.

  9. Choi MK, Kim SM, Lim JK. Diagnostic efficacy of Hounsfield units in spine CT for the assessment of real bone mineral density of degenerative spine: correlation study between T-scores determined by DEXA scan and Hounsfield units from CT. Acta Neurochir (Wien). 2016; 158: 1421-1427. doi: 10.1007/s00701-016-2821-5.

  10. Bazán PL, Jordan RC, Cevallos JRM, Adaro AO, Adaro JCS. Hounsfield units use in spinal surgery planning: systematic review and meta-analysis. Coluna/Columna. 2022; 21: e264579. doi: 10.1590/S1808-185120222103264579

  11. Chen JW, McCandless MG, Bhandarkar AR, Flanigan PM, Lakomkin N, Mikula AL, et al. The association between bone mineral density and proximal junctional kyphosis in adult spinal deformity: a systematic review and meta-analysis. J Neurosurg Spine. 2023; 39: 82-91. doi: 10.3171/223.2.SPINE221101.

  12. Flanigan PM, Mikula AL, Peters PA, Oushy S, Fogelson JL, Bydon M, et al. Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment. Neurosurg Focus. 2020; 49: e11. doi: 10.3171/220.5.FOCUS2273.

  13. Amin MFM, Zakaria WMW, Yahya N. Correlation between Hounsfield unit derived from head, thorax, abdomen, spine and pelvis CT and t-scores from DXA. Skeletal Radiol. 2021; 50: 2525-2535. doi: 10.1007/s0256-21-03801-z.

  14. Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011; 93: 1057-1063. doi: 10.2106/JBJS.J.00160.

  15. Dimar J, Bisson EF, Dhall S, Harrop JS, Hoh DJ, Mohamed B, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines for perioperative spine: preoperative osteoporosis assessment. Neurosurgery. 2021; 89: S19-S25. doi: 10.1093/neuros/nyab317.

  16. Zaidi Q, Danisa OA, Cheng W. Measurement techniques and utility of Hounsfield unit values for assessment of bone quality prior to spinal instrumentation: a review of current literature. Spine (Phila Pa 1976). 2019; 44: e239-e244. doi: 10.1097/BRS.000000000002813.

  17. Aydin-Ozturk P, Arac E, Ozturk U, Arac S. Estimation of bone mineral density with hounsfield unit measurement. Br J Neurosurg. 2024; 38: 464-467. doi: 10.1080/2688697.221.1888877.

  18. Zou D, Jiang S, Zhou S, Sun Z, Zhong W, Du G, et al. Prevalence of osteoporosis in patients undergoing lumbar fusion for lumbar degenerative diseases: a combination of DXA and Hounsfield units. Spine (Phila Pa 1976). 2020; 45: e406-e410. doi: 10.1097/BRS.0000000000003284.

  19. Mousavi SZ, Moshfeghinia R, Molavi-Vardanjani H, Sasani MR. Opportunistic screening of osteoporosis by CT scan compared to DXA: a systematic review and meta-analysis. Clin Imaging. 2025; 118: 110372. doi: 10.1016/j.clinimag.224.110372.

  20. Khadivi G, Akhtari A, Sharifi F, Zargarian N, Esmaeili S, Ahsaie MG, et al. Diagnostic accuracy of artificial intelligence models in detecting osteoporosis using dental images: a systematic review and meta-analysis. Osteoporos Int. 2025; 36: 1-19. doi: 10.1007/s00198-24-07229-8.

  21. Yamamoto N, Shiroshita A, Kimura R, Kamo T, Ogihara H, Tsuge T. Diagnostic accuracy of chest X-ray and CT using artificial intelligence for osteoporosis: systematic review and meta-analysis. J Bone Miner Metab. 2024; 42: 483-491. doi: 10.1007/s00774-24-01532-4.

  22. Hu F, Li X, Zhao D, Chen C, Liu G, Yang Q. The diagnostic value of MRI-based vertebral bone quality score for osteoporosis or osteopenia in patients undergoing lumbar surgery: a meta-analysis. Osteoporos Int. 2024; 35: 1881-1895. doi: 10.1007/s00198-24-07190-6.

  23. Alemán OLE, Ladewing BG, Canales NJA, Hurtado PA, Abrego SAA. Relación entre unidades Hounsfield en tomografía axial computarizada de columna lumbar y la densitometría ósea. Cir Columba. 2026; 4: 110-115. doi: 10.353.66/122422.




Table 1
Table 2
CC BY-NC-ND

2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Cir Columna. 2026;4