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Opportunistic Screening Using Low-Dose CT and the Prevalence of Osteoporosis in China: A Nationwide, Multicenter Study

Xiaoguang Cheng 1Kaiping Zhao 2Xiaojuan Zha 3Xia Du 4Yongli Li 5Shuang Chen 6Yan Wu 7Shaolin Li 8Yong Lu 9Yuqin Zhang 10Xigang Xiao 11YueHua Li 12Xiao Ma 13Xiangyang Gong 14Wei Chen 15Yingying Yang 3Jun Jiao 4Bairu Chen 5Yinru Lv 6Jianbo Gao 7GuoBin Hong 8Yaling Pan 9Yan Yan 3Huijuan Qi 3Limei Ran 16Jian Zhai 17Ling Wang 1Kai Li 1Haihong Fu 18Jing Wu 19Shiwei Liu 19Glen M Blake 20Perry Pickhardt 21Yuanzheng Ma 22Xiaoxia Fu 23Shengyong Dong 24Qiang Zeng 24Zhiping Guo 25Karen Hind 26Klaus Engelke 27Wei Tian 28China Health Big Data (China Biobank) project investigators

J Bone Miner Res doi: 10.1002/jbmr.4187. 

Abstract

Opportunistic screening for osteoporosis can be performed using low-dose computed tomography (LDCT) imaging obtained for other clinical indications. In this study we explored the CT-derived bone mineral density (BMD) and prevalence of osteoporosis from thoracic LDCT in a large population cohort of Chinese men and women. A total of 69,095 adults (40,733 men and 28,362 women) received a thoracic LDCT scan for the purpose of lung cancer screening between 2018 and 2019, and data were obtained for analysis from the China Biobank Project, a prospective nationwide multicenter population study. Lumbar spine (L1 -L2 ) trabecular volumetric bone mineral density (vBMD) was derived from these scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis were applied. Geographic regional differences in the prevalence of osteoporosis were assessed and the age-standardized, population prevalence of osteoporosis in Chinese men and women was estimated from the 2010 China census. The prevalence of osteoporosis by QCT for the Chinese population aged >50 years was 29.0% for women and 13.5% for men, equating to 49.0 million and 22.8 million, respectively. In women, this rate is comparable to estimates from dual-energy X-ray absorptiometry (DXA), but in men, the prevalence is double. Prevalence varied geographically across China, with higher rates in the southwest and lower rates in the northeast. Trabecular vBMD decreased with age in both men and women. Women had higher peak trabecular vBMD (185.4 mg/cm3 ) than men (176.6 mg/cm3 ) at age 30 to 34 years, but older women had lower trabecular vBMD (62.4 mg/cm3 ) than men (92.1 mg/cm3 ) at age 80 years. We show that LDCT-based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).