Comparison of DXA-based versus CT-based indices to predict prevalent fracture history in men with spinal cord injury

Michael J. Matthews, Karen L. Troy, Ricardo A. Battaglino, Nguyen Nguyen, Richard Goldstein, Leslie R. Morse

Research output: Contribution to journalArticlepeer-review


Summary: Fracture risk prediction remains challenging in adults with spinal cord injury. Here, we compare the ability of CT- and DXA-derived indices to discriminate between those with and without prevalent osteoporotic fracture. Novel CT-derived indices may offer improved assessment of fragility fracture risk as well as improved monitoring of response to therapies. Introduction: Individuals with spinal cord injury are particularly susceptible to osteoporosis. As advanced imaging techniques become more readily available clinically, there is limited information on the relative strength of various outcomes for fracture risk prediction. The purpose of this study was to compare the ability of DXA-based versus CT-based indices to predict prevalent fracture history in adults with spinal cord injury. Methods: Thirty-six men with known SCI underwent dual energy X-ray absorptiometry and computed tomography assessments of the lower extremities. We used age-adjusted area under the curve models to compare the predictive value for each bone parameter to identify prevalent fracture history. Results: CT-based indices outperformed DXA-based indices at all sites. The site with the highest AUC was the trabecular BMD at the proximal tibial epiphysis. Conclusions: CT imaging may have clinical utility to improve fracture risk prediction in adults with SCI. More work is needed to confirm these findings and to assess the value of CT-based indices to predict incident fracture, monitor longitudinal bone loss, and monitor response to various therapies, both pharmacological and rehabilitation.

Original languageEnglish (US)
Pages (from-to)319-325
Number of pages7
JournalOsteoporosis International
Issue number2
StatePublished - Feb 2023

Bibliographical note

Funding Information:
This work was supported by the Office of the Secretary of Defense for Health Affairs through the Spinal Cord Injury Clinical Trial Program under Award Numbers W81XWH-15-2-0078 and W81XWH-10-1-1043. Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

Publisher Copyright:
© 2022, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.


  • Bone density
  • Fracture
  • Osteoporosis

PubMed: MeSH publication types

  • Journal Article


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