ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASEValidation of a CT-Derived Method for Osteoporosis Screening in IBD Patients Undergoing Contrast-Enhanced CT EnterographyWeber, Nicholas K MD1; Fidler, Jeff L MD2; Keaveny, Tony M PhD3, 4; Clarke, Bart L MD5; Khosla, Sundeep MD5; Fletcher, Joel G MD2; Lee, David C PhD3; Pardi, Darrell S MD1; Loftus, Edward V Jr MD1; Kane, Sunanda V MD1; Barlow, John M MD2; Murthy, Naveen S MD2; Becker, Brenda D CCRP1; Bruining, David H MD1Author Information 1 Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA 2 Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA 3 O.N. Diagnostics, Berkeley, California, USA 4 Departments of Mechanical Engineering and Bioengineering, UC Berkeley, California, USA 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota, USA Correspondence: David H. Bruining, MD, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, Minnesota 55905, USA. E-mail: email@example.com Received 29 July 2013; accepted 12 December 2013 published online 21 January 2014 Presented in part at the 2013 Digestive Disease Week Meeting, Orlando, Florida, USA. American Journal of Gastroenterology: March 2014 - Volume 109 - Issue 3 - p 401-408 doi: 10.1038/ajg.2013.478 Buy Metrics Abstract OBJECTIVES: Osteoporosis and bone fractures are of particular concern in patients with inflammatory bowel disease (IBD). Biomechanical computed tomography (BCT) is an image-analysis technique that can measure bone strength and dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) from noncontrast CT images. This study seeks to determine whether this advanced technology can be applied to patients with IBD undergoing CT enterography (CTE) with IV contrast. METHODS: Patients with IBD who underwent a CTE and DXA scan between 2007 and 2011 were retrospectively identified. Femoral neck BMD (g/cm2) andT-scores were measured and compared between DXA and BCT analysis of the CTE images. Femoral strength (Newtons) was also determined from BCT analysis. RESULTS: DXA- and CTE-generated BMDT-score values were highly correlated (R2=0.84,P<0.0001) in this patient cohort (n=136). CTE identified patients with both osteoporosis (sensitivity, 85.7%; 95% confidence interval (CI), 48.7–97.4 and specificity, 98.5%; 95% CI, 94.5–99.6) and osteopenia (sensitivity, 85.1%; 95% CI, 72.3–92.6 and specificity, 85.4%; 95% CI, 76.6–91.3). Of the 16 patients who had “fragile” bone strength by BCT (placing them at the equivalent high risk of fracture as for osteoporosis), 6 had osteoporosis and 10 had osteopenia by DXA. CONCLUSIONS: CTE scans can provide hip BMD,T-scores, and clinical classifications that are comparable to those obtained from DXA; when combined with BCT analysis, CTE can identify a subset of patients with osteopenia who have clinically relevant fragile bone strength. This technique could markedly increase bone health assessments in IBD patients already undergoing CTE to evaluate small bowel disease. © The American College of Gastroenterology 2014. All Rights Reserved.