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Utility of Radiographic Parameter in Assessing Bone Density and Subsequent Fractures in Patients With Osteoporotic Vertebral Compression Fracture: Yunsheng Wang, Mei Dong, Jiali Zhang, Dechao Miao, Feng Wang, Tong Tong, Linfeng Wang; Neurospine 2024;21(3):966-972. Published online September 30, 2024; DOI: https://doi.org/10.14245/ns.2448310.155

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Utility of Radiographic Parameter in Assessing Bone Density and Subsequent Fractures in Patients With Osteoporotic Vertebral Compression Fracture

Neurospine. 2024;21(3):966-972. Published online September 30, 2024

DOI: https://doi.org/10.14245/ns.2448310.155

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Utility of Radiographic Parameter in Assessing Bone Density and Subsequent Fractures in Patients With Osteoporotic Vertebral Compression Fracture

Neurospine. 2024;21(3):966-972. Published online September 30, 2024

DOI: https://doi.org/10.14245/ns.2448310.155

Objective
To investigate the ability of radiological parameter canal bone ratio (CBR) to assess bone mineral density and to differentiate between patients with primary and multiple osteoporotic vertebral compression fracture (OVCF).
Methods
A retrospective analysis was conducted on OVCF patients treated at our hospital. CBR was measured through full-spine x-rays. Patients were categorized into primary and multiple fracture groups. Receiver operating characteristic curve analysis and area under the curve (AUC) calculation were used to assess the ability of parameters to predict osteoporosis and multiple fractures. Predictors of T values were analyzed by multiple linear regression, and independent risk factors for multiple fractures were determined by multiple logistic regression analysis.
Results
CBR showed a moderate negative correlation with dual-energy x-ray absorptiometry T values (r = -0.642, p < 0.01). Higher CBR (odds ratio [OR], -6.483; 95% confidence interval [CI], -8.234 to -4.732; p < 0.01) and lower body mass index (OR, 0.054; 95% CI, 0.023–0.086; p < 0.01) were independent risk factors for osteoporosis. Patients with multiple fractures had lower T values (mean ± standard deviation [SD]: -3.76 ± 0.73 vs. -2.83 ± 0.75, p < 0.01) and higher CBR (mean ± SD: 0.54 ± 0.07 vs. 0.46 ± 0.06, p < 0.01). CBR had an AUC of 0.819 in predicting multiple fractures with a threshold of 0.53. T values prediction had an AUC of 0.816 with a threshold of -3.45. CBR > 0.53 was an independent risk factor for multiple fractures (OR, 14.66; 95% CI, 4.97–43.22; p < 0.01).
Conclusion
CBR is negatively correlated with bone mineral density (BMD) and can be a novel opportunistic BMD assessment method. It is a simple and effective measurement index for predicting multiple fractures, with predictive performance not inferior to T values.

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Bone Biology and Osteoporosis Special Issue

Which Indicator Among Lumbar Vertebral Hounsfield Unit, Vertebral Bone Quality, or Dual-Energy X-Ray Absorptiometry-Measured Bone Mineral Density Is More Efficacious in Predicting Thoracolumbar Fragility Fractures?: Bo Zhang, Lu-Ping Zhou, Xian-Liang Zhang, Dui Li, Jia-Qi Wang, Chong-Yu Jia, Hua-Qing Zhang, Liang Kang, Ren-Jie Zhang, Cai-Liang Shen; Neurospine 2023;20(4):1193-1204. Published online December 31, 2023; DOI: https://doi.org/10.14245/ns.2346998.499

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Which Indicator Among Lumbar Vertebral Hounsfield Unit, Vertebral Bone Quality, or Dual-Energy X-Ray Absorptiometry-Measured Bone Mineral Density Is More Efficacious in Predicting Thoracolumbar Fragility Fractures?

Neurospine. 2023;20(4):1193-1204. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346998.499

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Neurospine. 2023;20(4):1193-1204. Published online December 31, 2023

DOI: https://doi.org/10.14245/ns.2346998.499

Objective
Hounsfield units (HU), vertebral bone quality (VBQ), and bone mineral density (BMD) can all serve as predictive indicators for thoracolumbar fragility fractures. This study aims to explore which indicator provides better risk prediction for thoracolumbar fragility fractures.
Methods
Patients who have received medical attention from The First Affiliated Hospital of Anhui Medical University for thoracolumbar fragility fractures were selected. A total of 78 patients with thoracolumbar fragility fractures were included in the study. To establish a control group, 78 patients with degenerative spinal diseases were matched to the fracture group on the basis of gender, age, and body mass index. The lumbar vertebral HU, the VBQ, and the BMD were obtained for all the 156 patients through computed tomography, magnetic resonance imaging, and dual-energy x-ray absorptiometry (DEXA). The correlations among these parameters were analyzed. The area under curve (AUC) analysis was employed to assess the predictive efficacy and thresholds of lumbar vertebral HU, VBQ, and BMD in relation to the risk of thoracolumbar fragility fractures.
Results
Among the cohort of 156 patients, lumbar vertebral HU exhibited a positive correlation with BMD (p < 0.01). Conversely, VBQ showed a negative correlation with HU, BMD (p < 0.05). HU and BMD displayed a favorable predictive efficacy for thoracolumbar fragility fractures (p < 0.01), with HU (AUC = 0.863) showcasing the highest predictive efficacy, followed by the DEXA-measured BMD (AUC = 0.813). VBQ (AUC = 0.602) ranked lowest among the 3 indicators. The thresholds for predicting thoracolumbar fragility fractures were as follows: HU (88),VBQ (3.37), and BMD (0.81).
Conclusion
All 3 of these indicators, HU, VBQ, and BMD, can predict thoracolumbar fragility fractures. Notably, lumbar vertebral HU exhibits the highest predictive efficacy, followed by the BMD obtained through DEXA scanning, with VBQ demonstrating the lowest predictive efficacy.

Citations

Citations to this article as recorded by

Evaluation of bone mineral density in patients with cervical ossification of the posterior longitudinal ligament utilizing vertebral bone quality and Hounsfield units
Kangcheng Zhao, Tong Su, JuHan Li, WeiBo Huang, HuaBin Yin
European Spine Journal.2026; 35(4): 1785. CrossRef
Comparison between Hounsfield unit value and vertebral bone quality score for adjacent vertebral fracture risk assessment after balloon kyphoplasty: a propensity score matching study
Koji Matsumoto, Masahiro Hoshino, Hirokatsu Sawada, Sosuke Saito, Tomohiro Furuya, Hirohiko Tsujisawa, Ryo Ozaki, Kazuyoshi Nakanishi
Asian Spine Journal.2026; 20(1): 52. CrossRef
Disuse Bone Loss in Fusion Constructs After Multilevel Lumbar Fusion: A Computed Tomography Hounsfield Unit Analysis
Hyun-Jun Jang, Dongkyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Dong-Kyu Chin
Neurospine.2026; 23(1): 176. CrossRef
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Shangshu Wei, Sizheng Zhan, Yanjun Huang, Danning Lu, Chenxu Liu, Haoning Ma, Ping Yi, Xiangsheng Tang
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Han Ke, Minghui Liang, Yu Xi, Ruiyuan Chen, Congying Zou, Tianyi Wang, Aobo Wang, Ziqian Ma, Ning Fan, Shuo Yuan, Lei Zang
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Osteoporosis International.2026;[Epub] CrossRef
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Xiaoteng Li, Fengzi Lv, Xin Tang, Peng Jia, Yang Gao
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Global Spine Journal.2025; 15(4): 2226. CrossRef
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Does Baseline Hounsfield Unit Predict Patients’ Outcomes Following Surgical Management of Unstable Osteoporotic Thoracolumbar Fractures?
Ahmed Qretam, Julien Ceuterick, Maher Ghandour, Ümit Mert, Christian Herren, Miguel Pishnamaz, Matthias Knobe, Frank Hildebrand, Rolf Sobottke, Mohamad Agha Mahmoud
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Clinical Article

Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament: Ki-Wan Kim, Young-Min Oh, Jong-Pil Eun; Korean J Spine 2016;13(3):139-143. Published online September 30, 2016; DOI: https://doi.org/10.14245/kjs.2016.13.3.139

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Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

Korean J Spine. 2016;13(3):139-143. Published online September 30, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.3.139

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Increased Prevalence of Ossification of Posterior Longitudinal Ligament and Increased Bone Mineral Density in Patients with Ossification of Nuchal Ligament

Korean J Spine. 2016;13(3):139-143. Published online September 30, 2016

DOI: https://doi.org/10.14245/kjs.2016.13.3.139

Objective

There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups.

Methods

total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups.

Results

The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL.

Conclusion

The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.

Citations

Citations to this article as recorded by

Anatomical variability, morphofunctional characteristics, and clinical relevance of accessory ossicles of the back: implications for spinal pathophysiology and differential diagnosis
Eren Ogut
Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
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Chong Chen, Wenlin Ye, Tao Yu, Xing Cheng, Lutong Wang, Xingchen Zhao, Xiang Long, Jun Ouyang, Yunbing Chang, Xiaoqing Zheng
BMC Musculoskeletal Disorders.2025;[Epub] CrossRef
Is the Ossification of the Posterior Longitudinal Ligament a Positive Factor for the Fusion after Posterior Cervical Fusion and Decompression?
Jun-Woo Ha, Bong Ju Moon, Kwang-Ryeol Kim, Kyung Hyun Kim, Jeong Yoon Park, Dong Kyu Chin, Yong Eun Cho, Keun Su Kim, Hyun Jun Jang
The Nerve.2024; 10(2): 89. CrossRef
Potential Link between Ossification of Nuchal Ligament and the Risk of Cervical Ossification of Posterior Longitudinal Ligament: Evidence and Clinical Implication from a Meta‐Analysis of 8429 Participants
Baoliang Zhang, Guanghui Chen, Xingshuai Gao, Zhongqiang Chen
Orthopaedic Surgery.2021; 13(3): 1055. CrossRef
Surgery for cervical ossification of posterior longitudinal ligament (OPLL) via posterior laminoplasty
Xiaoqing Chen, Jie Hao, Ting Fu, Rongqin Qin, Feng Zhang
Interdisciplinary Neurosurgery.2020; 19: 100562. CrossRef
Factors associated with bone metabolism in patients with cervical ossification of the posterior longitudinal ligament accompanied with diffuse idiopathic skeletal hyperostosis
Shinji Horie, Yasunobu Sawaji, Kenji Endo, Hidekazu Suzuki, Yuji Matsuoka, Hirosuke Nishimura, Takeshi Seki, Kengo Yamamoto
SICOT-J.2018; 4: 7. CrossRef
Radiographic Features and Correlation Analysis of Location of Ossification in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Combined with Ossification of the Nuchal Ligament
Bo Yuan, Zhiwei Wang, Yin Zhao, Guofeng Xu, Shengyuan Zhou, Xiongsheng Chen, Lianshun Jia
World Neurosurgery.2018; 116: e929. CrossRef