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Purpose <p>This study aimed to investigate the diagnostic value of the mean bone mineral density (MBMD) of the mid-to-lower thoracic spine (T7–8 and T10–11) for osteoporosis and osteopenia, and to establish corresponding diagnostic criteria.</p> Methods <p>We retrospectively analyzed data from patients who underwent chest and abdominal CT scans at our hospital and an external validation center between January 2023 and December 2024. The training set included 174 patients (with a subgroup of 134 patients aged ≥ 50&#xa0;years), and the validation set included 87 patients. The MBMD of T7–8, T10–11, and L1–2 was measured. Receiver operating characteristic (ROC) curves were used to determine diagnostic thresholds, and linear regression equations were established to standardize thoracic BMD to lumbar BMD (translated thoracic BMD, TTBMD). Diagnostic consistency was assessed using the Kappa test and Bland–Altman analysis.</p> Results <p>In the subgroup aged ≥ 50&#xa0;years, MBMD (T7–8) and MBMD (T10–11) showed a strong positive correlation with MBMD (L1–2) (r = 0.94 and 0.96, respectively). Linear regression conversion equations were established, with coefficients of determination (R<sup>2</sup>) of 0.88 and 0.92, respectively. ROC curve analysis revealed that the optimal thresholds for MBMD (T7–8) to diagnose osteoporosis and osteopenia were 96.2&#xa0;mg/cm<sup>3</sup> (AUC = 0.93) and 146.7&#xa0;mg/cm<sup>3</sup> (AUC = 0.96), respectively. The corresponding thresholds for MBMD (T10–11) were 100.6&#xa0;mg/cm<sup>3</sup> (AUC = 0.96) and 137.7&#xa0;mg/cm<sup>3</sup> (AUC = 0.98), respectively. Both methods demonstrated good diagnostic consistency, with Kappa values of 0.81 for the T7–8 combination and 0.84 for the T10–11 combination. The validation set results showed good consistency between the diagnostic methods based on the aforementioned thresholds and regression equations compared with the gold standard (Kappa values of 0.70 and 0.65, respectively).</p> Conclusion <p>The MBMD of the mid-lower thoracic vertebrae (T7–8 and T10–11) demonstrates good diagnostic performance for low bone mass and osteoporosis, and can be extended to other relevant examinations that include these vertebral segments.</p>

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Assessing the diagnostic utility of thoracic BMD: external validation of regression models and cut-off values for mid-to-lower thoracic vertebrae against lumbar QCT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月17日

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  • Ran Gao,
  • Ze-Peng Ma,
  • Dan Zhang,
  • Fang Wang,
  • Shuang-Rui Yuan,
  • Ying-Jia Zhao,
  • Gao-Yang Li

摘要

Purpose

This study aimed to investigate the diagnostic value of the mean bone mineral density (MBMD) of the mid-to-lower thoracic spine (T7–8 and T10–11) for osteoporosis and osteopenia, and to establish corresponding diagnostic criteria.

Methods

We retrospectively analyzed data from patients who underwent chest and abdominal CT scans at our hospital and an external validation center between January 2023 and December 2024. The training set included 174 patients (with a subgroup of 134 patients aged ≥ 50 years), and the validation set included 87 patients. The MBMD of T7–8, T10–11, and L1–2 was measured. Receiver operating characteristic (ROC) curves were used to determine diagnostic thresholds, and linear regression equations were established to standardize thoracic BMD to lumbar BMD (translated thoracic BMD, TTBMD). Diagnostic consistency was assessed using the Kappa test and Bland–Altman analysis.

Results

In the subgroup aged ≥ 50 years, MBMD (T7–8) and MBMD (T10–11) showed a strong positive correlation with MBMD (L1–2) (r = 0.94 and 0.96, respectively). Linear regression conversion equations were established, with coefficients of determination (R2) of 0.88 and 0.92, respectively. ROC curve analysis revealed that the optimal thresholds for MBMD (T7–8) to diagnose osteoporosis and osteopenia were 96.2 mg/cm3 (AUC = 0.93) and 146.7 mg/cm3 (AUC = 0.96), respectively. The corresponding thresholds for MBMD (T10–11) were 100.6 mg/cm3 (AUC = 0.96) and 137.7 mg/cm3 (AUC = 0.98), respectively. Both methods demonstrated good diagnostic consistency, with Kappa values of 0.81 for the T7–8 combination and 0.84 for the T10–11 combination. The validation set results showed good consistency between the diagnostic methods based on the aforementioned thresholds and regression equations compared with the gold standard (Kappa values of 0.70 and 0.65, respectively).

Conclusion

The MBMD of the mid-lower thoracic vertebrae (T7–8 and T10–11) demonstrates good diagnostic performance for low bone mass and osteoporosis, and can be extended to other relevant examinations that include these vertebral segments.