The association between bone density evaluated on CT or MRI versus the gold standard dual-energy X-ray absorptiometry (DEXA) in the lumbar spine and hip: a meta-analysis
Abstract
Introduction: CT-based Hounsfield units (HU) and MRI-based vertebral bone quality (VBQ)-scores are opportunistic markers of bone mineral density and potential alternatives for dual-energy X-ray absorptiometry (DEXA).
Research question: What is the correlation between HU values and VBQ-scores in relation to DEXA, and what is the corresponding area-under-the-curve (AUC)-based diagnostic discrimination to detect osteopenia and osteoporosis?
Material and methods: PubMed, Embase, Web of Science, Cochrane Library, and CINAHL were searched through August 2025 for studies reporting correlations between DEXA and CT and/or MRI or the AUC-based diagnostic discrimination of CT and/or MRI to detect osteopenia and osteoporosis. Random effects models were used to calculate pooled correlation coefficients and AUC values along with 95% confidence intervals.
Results: Forty-three studies, including 8222 patients, were analyzed. HU demonstrated stronger correlations with DEXA T-scores than the VBQ-score (maximum correlation coefficient: 0.741 (95% CI: 0.578-0.847) vs. -0.476 (95% CI: -0.548 to -0.398) and greater AUC-based diagnostic discrimination for osteopenia and osteoporosis (maximum AUC: 0.875 (95% CI: 0.841-0.909) vs. 0.806 (95% CI: 0.684-0.929) across all vertebrae and DEXA sites. Correlation and AUC-based diagnostic discrimination of HU were consistent across vertebrae, with slightly better results at L2 and the mean of L1-L4. VBQ-score correlations were highest at L1 and gradually…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,222 participants or records.
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