What are the ISCD recommendations for quantitative CT (QCT) in the workup of osteoporosis?

Updated: Sep 26, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The following are the official positions of the International Society of Clinical Densitometry (ISCD) on QCT of the lumbar spine (ref31)

  • When using single-slice QCT, L1-L3 should be scanned; with 3D QCT, L1-L2 should be scanned

  • QCT of the spine can be used to predict vertebral fractures in postmenopausal women, but there is insufficient evidence to recommend spine QCT for spinal fracture prediction in men or hip fracture prediction in both women and men

  • Peripheral QCT (pQCT) of the forearm at the ultra-distal radius predicts hip, but not spine, fragility fractures in postmenopausal women; there is lack of sufficient evidence to support this position for men

  • Because T-scores by QCT are not equivalent to T-scores based on DXA, the World Health Organization (WHO) diagnostic classification of osteoporosis cannot be used

  • If central DXA measurements cannot be obtained, QCT of the spine or pQCT of the radius can be used to identify patients who are appropriate candidates for pharmacologic treatment; fracture probability based on both device-specific thresholds and clinical risk factors should be high in those patients

  • QCT of the spine can be used to monitor age-, disease- and treatment-related BMD changes via trabecular BMD of the lumbar spine


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