• Fabian Buenger, Yasser Sakr, Niklas Eckardt, Christian Senft, and Falko Schwarz.
• Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany.
• Arch Orthop Trauma Surg. 2022 Nov 1; 142 (11): 3335-3340.

IntroductionVertebral fractures in patients with bone density reduction are often a major challenge for the surgeon, as reduced bone density can lead to screw loosening. Several options are available to determine bone density preoperatively. In our study, we investigated the correlation of Hounsfield units (HU) of a contrast medium computed tomography (CT) to the bone density values of a quantitative computed tomography (QCT) and computed a formula to estimate bone density values using HU.Materials And MethodsIn our retrospective data analysis, we examine 98 vertebral bodies from 35 patients who received a contrast medium CT of the spine and a QCT, performed no longer than 1 month apart. The determined HU from the contrast medium CT were compared with the bone density values of the QCT and examined for correlations. Linear logistic regression was used to estimate bone density values base on HU.ResultsA strong correlation was found between the HU measured in the CT and the bone density values (r = 0.894, p < 0.001), irrespective of patients' gender. We also found no correlation differences when the HU were measured at different levels. Bland-Altman plot demonstrated good agreement between the two measurements. The following formula was developed to estimate bone density values using HU: QCT-value = 0.71 × HU + 13.82.ConclusionsBone density values correlate well to HU measured in contrast medium CT. Using simple formula, the bone density of a contrast medium CT of vertebral bodies can be estimated based on HU without additional examinations and unnecessary costs.© 2021. The Author(s).

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