Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

Article  PubMed  Google Scholar 

Force USPST, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Phipps MG, Pignone M, Silverstein M, Simon MA, Tseng CW, Wong JB (2018) Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA 319:2521–2531. https://doi.org/10.1001/jama.2018.7498

Article  Google Scholar 

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

Article  PubMed  Google Scholar 

Jang S, Graffy PM, Ziemlewicz TJ, Lee SJ, Summers RM, Pickhardt PJ (2019) Opportunistic osteoporosis screening at routine abdominal and thoracic CT: normative L1 trabecular attenuation values in more than 20,000 adults. Radiology 291:360–367. https://doi.org/10.1148/radiol.2019181648

Article  PubMed  Google Scholar 

Graffy PM, Lee SJ, Ziemlewicz TJ, Pickhardt PJ (2017) Prevalence of vertebral compression fractures on routine CT scans according to L1 trabecular attenuation: determining relevant thresholds for opportunistic osteoporosis screening. AJR Am J Roentgenol 209:491–496. https://doi.org/10.2214/AJR.17.17853

Article  PubMed  Google Scholar 

Pickhardt PJ, Pooler BD, Lauder T, del Rio AM, Bruce RJ, Binkley N (2013) Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 158:588–595. https://doi.org/10.7326/0003-4819-158-8-201304160-00003

Article  PubMed  PubMed Central  Google Scholar 

Urrutia J, Besa P, Piza C (2019) Incidental identification of vertebral compression fractures in patients over 60 years old using computed tomography scans showing the entire thoraco-lumbar spine. Arch Orthop Trauma Surg 139:1497–1503. https://doi.org/10.1007/s00402-019-03177-9

Article  PubMed  Google Scholar 

Perrier-Cornet J, Omorou AY, Fauny M, Loeuille D, Chary-Valckenaere I (2019) Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporos Int 30:1215–1222. https://doi.org/10.1007/s00198-019-04931-w

Article  PubMed  Google Scholar 

Alacreu E, Moratal D, Arana E (2017) Opportunistic screening for osteoporosis by routine CT in Southern Europe. Osteoporos Int 28:983–990. https://doi.org/10.1007/s00198-016-3804-3

Article  PubMed  Google Scholar 

Lee SJ, Graffy PM, Zea RD, Ziemlewicz TJ, Pickhardt PJ (2018) Future osteoporotic fracture risk related to lumbar vertebral trabecular attenuation measured at routine body CT. J Bone Miner Res 33:860–867. https://doi.org/10.1002/jbmr.3383

Article  PubMed  Google Scholar 

Fang J, Franconeri A, Boos J, Nimhuircheartaigh J, Zhang Z, Brook A, Brook OR (2018) Opportunistic bone density measurement on abdomen and pelvis computed tomography to predict fracture risk in women aged 50 to 64 years without osteoporosis risk factors. J Comput Assist Tomogr 42:798–806. https://doi.org/10.1097/RCT.0000000000000744

Article  PubMed  Google Scholar 

Xie F, Yang Z, Tu Z, Huang P, Wang Z, Luo Z, Hu X (2022) The value of Hounsfield units in predicting cage subsidence after transforaminal lumbar interbody fusion. BMC Musculoskelet Disord 23:882. https://doi.org/10.1186/s12891-022-05836-2

Article  PubMed  PubMed Central  Google Scholar 

Zou D, Sun Z, Zhou S, Zhong W, Li W (2020) Hounsfield units value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases. Eur Spine J 29:1105–1111. https://doi.org/10.1007/s00586-020-06386-8

Article  PubMed  Google Scholar 

Pinter ZW, Mikula AL, Townsley SE, Salmons Iv HI, Lakomkin N, Michalopoulos GD, Nassr A, Freedman BA, Bydon M, Fogelson J, Sebastian AS, Elder BD (2023) Lower hounsfield units and severe multifidus sarcopenia are independent predictors of increased risk for proximal junctional kyphosis and failure following thoracolumbar fusion. Spine (Phila Pa 1976) 48:223–231. https://doi.org/10.1097/BRS.0000000000004517

Article  PubMed  Google Scholar 

Yao YC, Elysee J, Lafage R, McCarthy M, Louie PK, Alshabab BS, Weissmann K, Lafage V, Schwab F, Kim HJ (2021) Preoperative hounsfield units at the planned upper instrumented vertebrae may predict proximal junctional kyphosis in adult spinal deformity. Spine (Phila Pa 1976) 46:E174–E180. https://doi.org/10.1097/BRS.0000000000003798

Article  PubMed  Google Scholar 

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L, Injury AOSC, Trauma Knowledge F (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38:2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381

Article  PubMed  Google Scholar 

Kubota T, Yamada K, Ito H, Kizu O, Nishimura T (2005) High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and malignant vertebral compression fractures. J Comput Assist Tomogr 29:712–719

Article  PubMed  Google Scholar 

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148. https://doi.org/10.1002/jbmr.5650080915

Article  PubMed  Google Scholar 

Mooney J, Morgan S, Brockington D, Rehder D, Rothenberg S, Omar N, MacLennan P, Chambers MR (2022) Inter-rater reliability and correlation of L1 hounsfield unit measurements with DXA scores. J Clin Densitom 25:668–673. https://doi.org/10.1016/j.jocd.2022.09.002

Article  PubMed  Google Scholar 

Fleiss J (1986) The design and analysis of clinical experiments. Wiley, New York, pp 1–31

Google Scholar 

Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone 34:195–202. https://doi.org/10.1016/j.bone.2003.10.001

Article  PubMed  Google Scholar 

Zaidi Q, Danisa OA, Cheng W (2019) 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) 44:E239–E244. https://doi.org/10.1097/BRS.0000000000002813

Article  Google Scholar 

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

Article  PubMed  Google Scholar 

Viswanathan VK, Shetty AP, Rai N, Sindhiya N, Subramanian S, Rajasekaran S (2023) What is the role of CT-based Hounsfield unit assessment in the evaluation of bone mineral density in patients undergoing 1- or 2-level lumbar spinal fusion for degenerative spinal pathologies? A prospective study. Spine J 23:1427–1434. https://doi.org/10.1016/j.spinee.2023.05.015

Article  PubMed  Google Scholar 

Choi MK, Kim SM, Lim JK (2016) 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) 158:1421–1427. https://doi.org/10.1007/s00701-016-2821-5

Article  PubMed  Google Scholar 

Pu X, Geng C, Xiao W, Gu S, Wang D, Liu C, Li H, Liu B (2024) Simultaneous comparison of three methods for bone quality assessment. Eur Spine J. https://doi.org/10.1007/s00586-024-08532-y

Article  PubMed  Google Scholar 

Sardar ZM, Coury JR, Cerpa M, DeWald CJ, Ames CP, Shuhart C, Watkins C, Polly DW, Dirschl DR, Klineberg EO, Dimar JR, Krohn KD, Kebaish KM, Tosi LL, Kelly M, Lane NE, Binkley NC, Berven SH, Lee NJ, Anderson P, Angevine PD, Lehman RA, Lenke LG (2022) Best practice guidelines for assessment and management of osteoporosis in adult patients undergoing elective spinal reconstruction. Spine (Phila Pa 1976) 47:128–135. https://doi.org/10.1097/BRS.0000000000004268

Article  PubMed  Google Scholar 

Aggarwal V, Maslen C, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, Ward KA, Poole KES (2021) Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation. Ther Adv Musculoskelet Dis 13:1759720X211024029. https://doi.org/10.1177/1759720X211024029

Article  PubMed  PubMed Central  Google Scholar 

Agaronnik ND, Giberson-Chen C, Bono CM (2024) Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery. Spine J 24:1135–1152. https://doi.org/10.1016/j.spinee.2024.02.018

Article  PubMed  Google Scholar 

Taniwaki H, Hoshino M, Kinoshita Y, Matsumura A, Namikawa T, Kato M, Takahashi S, Nakamura H (2024) Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Eur Spine J 33:11–18. https://doi.org/10.1007/s00586-023-07995-9