Asynchronous quantitative computed tomography in outpatient settings
Introduction The prevalence of osteoporosis is predicted to increase among individuals over 50 years of age. Research was initiated to evaluate the effectiveness of the clinical use of asynchronous quantitative computed tomography (QCT) facilitating the diagnosis of the condition. Objective Review the results of asynchronous QCT introduced in an outpatient clinic in Moscow, with reference to the risk factors included in the FRAX tool. Material and methods Bone mineral density (BMD) was measured in patients referred for QCT by specialized clinicians employed at the same medical institution. The QCT scanning included two areas: the lumbar spine and the proximal femur and was produced with the Toshiba Aquilion 64 CT Scanner, and BMD measured using QCT PRO. A sampling analysis of the 10-year probability of a major osteoporotic fracture was produced using the FRAX tool with the exclusion criteria of anti-osteoporotic treatment, unreliable data in the questionnaire, artifacts in the images of the proximal femur. Based on the results, patients were assigned to groups by indications for initiating treatment in accordance with the FRAX strategies, FRAX corrected for BMD of the femoral neck, QCT, FRAX in conjunction with QCT. Results Within a year of the study, QCT scans were performed for 710 women with the mean age (MA) of 67.3 (9.3) years. Based on CT findings of three sites of interest patients were diagnosed with osteoporosis (n = 418, 59 %), osteopenia (n = 252, 35 %), and 40 (6 %) showed normal manifestations. The FRAX-based 10-year probability of major osteoporotic fractures was used selectively for 111 patients with a high risk detected in 15.2 %, and BMD of the femoral neck adjusted in 14.3 %. QCT findings revealed a high risk of fractures in 46.4 % of the surveyed patients who could receive treatment. The use of QCT in addition to FRAX allowed optimal identification of patients who had antiresorptive treatment indicated in 30.4 %. Conclusion QCT findings detected osteoporosis in 59 % of patients, while the FRAX-based estimates of 10-year fracture probabilities indicated to the need for initiation of treatment in 15.2 % only. Using the FRAX tool and QCT findings together allowed optimization in the proportion of patients who required anti-osteoporotic treatment up to 30.4 %. The results of the study can be used in the development of a clinical decision support system for management of patients with suspected osteoporosis.