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Osteoporosis markers on low-dose lung cancer screening chest computed tomography scans predict all-cause mortality

  • Computed Tomography
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Abstract

Objectives

Further survival benefits may be gained from low-dose chest computed tomography (CT) by assessing vertebral fractures and bone density. We sought to assess the association between CT-measured vertebral fractures and bone density with all-cause mortality in lung cancer screening participants.

Methods

Following a case-cohort design, lung cancer screening trial participants (N = 3,673) who died (N = 196) during a median follow-up of 6 years (inter-quartile range: 5.7–6.3) were identified and added to a random sample of N = 383 from the trial. We assessed vertebral fractures using Genant´s semiquantative method on sagittal reconstructions and measured bone density (Hounsfield Units (HU)) in vertebrae. Cox proportional hazards modelling was used to determine if vertebral fractures or bone density were independently predictive of mortality.

Results

The prevalence of vertebral fractures was 35 % (95 % confidence interval 30–40 %) among survivors and 51 % (44–58 %) amongst cases. After adjusting for age, gender, smoking status, pack years smoked, coronary and aortic calcium volume and pulmonary emphysema, the adjusted hazard ratio (HR) for vertebral fracture was 2.04 (1.43–2.92). For each 10 HU decline in trabecular bone density, the adjusted HR was 1.08 (1.02–1.15).

Conclusions

Vertebral fractures and bone density are independently associated with all-cause mortality.

Key Points

• Lung cancer screening chest computed tomography contains additional, potentially useful information.

• Vertebral fractures and bone density are independently predictive of mortality.

• This finding has implications for screening and management decisions.

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Acknowledgments

The scientific guarantor of this publication is PAJ. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The NELSON-trial was supported by the Netherlands Organisation for Health Research and Development; Dutch Cancer Society Koningin Wilhelmina Fonds; Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen; Siemens Germany; Rotterdam Oncologic Thoracic Steering Committee; and the G. Ph. Verhagen Trust, Flemish League Against Cancer, Foundation Against Cancer, and Erasmus Trust Fund. Buckens was further funded by an unrestricted program grant from the Netherlands Organization for Scientific Research-Medical Sciences (NWO-MW) grant 40-00812-98-07-005. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some NELSON study subjects or cohorts (Electronic Supplementary Material) have been previously reported in various other journals. Methodology: prospective, case-cohort study, multicenter study.

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Authors and Affiliations

  1. Radiology Department, University Medical Center Utrecht, Heidelberglaan 100, E01.1A32, 3508 GA, Utrecht, The Netherlands

    C. F. Buckens, H. M. Verkooijen, W. P. Mali & P. A. de Jong

  2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    C. F. Buckens & Y. van der Graaf

  3. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    I. Isgum & C. P. Mol

  4. Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    H. J. Verhaar

  5. Department of Radiology, Medical Center Groningen, Utrecht, The Netherlands

    R. Vliegenthart & M. Oudkerk

  6. Department of Public Health, Erasmus MC Rotterdam, Rotterdam, The Netherlands

    C. M. van Aalst & H. J. de Koning

Authors
  1. C. F. Buckens
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  2. Y. van der Graaf
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  3. H. M. Verkooijen
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  4. W. P. Mali
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  5. I. Isgum
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  6. C. P. Mol
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  7. H. J. Verhaar
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  8. R. Vliegenthart
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  9. M. Oudkerk
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  10. C. M. van Aalst
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  11. H. J. de Koning
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  12. P. A. de Jong
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Corresponding author

Correspondence to P. A. de Jong.

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Buckens, C.F., van der Graaf, Y., Verkooijen, H.M. et al. Osteoporosis markers on low-dose lung cancer screening chest computed tomography scans predict all-cause mortality. Eur Radiol 25, 132–139 (2015). https://doi.org/10.1007/s00330-014-3361-0

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