A new method for guiding the use of cement reinforced screws: The combination method was used to determine osteoporosis

Abstract Objective To accurately judge the preoperative osteoporosis of patients, it is planned to develop a more accurate evaluation method of osteoporosis and better guide the use of bone cement reinforced screws. Method The patients WHO had undergone posterior lumbar decompression and fusion internal fixation in Shanghai Tongren Hospital were retrospectively analyzed. The general information, bone mineral density assessment data, Fracture risk prediction rate(WHO Fracture Risk Assessment Tool (FRAX)), and whether to use cement reinforced screws were collected.Definition of combination method: T value<-2.5 or HU value < 110 or VBQ > 3.5.The diagnostic rates of osteoporosis were compared between DXA, HU, VBQ, NBHA, and combination methods, and the correlation between different methods was analyzed. Binary logistic regression was used to analyze the significant influencing factors of the use of cement-reinforced screws. Result A total of 178 patients were enrolled in the study, aged 65.73 ± 14.43 years, 121 female, 57 male, BMI was 22.88 ± 3.52, 57 (32.0%) used cement reinforced screws, and 14 (7.9%) had previous fracture history.The diagnostic rates of osteoporosis by DXA, HU, VBQ, NBHA and combination method were 22.5% (40/178), 47.2% (84/178), 56.2% (100/178), 64.0% (114/178) and 75.8% (135/178), respectively.HU, VBQ, NBHA, and combination methods were significantly different from DXA in the diagnosis rate of osteoporosis (P < 0.001). Binary Logistics regression showed that age, T value, HU value, and VBQ value significantly influenced bone cement screw use, and the odds ratio of VBQ was 4.315. The prediction accuracy of the regression equation was 90.4%, the area under the ROC curve was 0.974, and the Youden index was 0.830. Conclusion At present, the most widely used DXA method for the diagnosis of osteoporosis has false negative results, and there are great differences among different methods for the diagnosis of osteoporosis. The detection rate of the combined method for osteoporosis is higher than other methods (75.8%). Age, T value, HU value, and VBQ value were significant influencing factors for the use of cement screws, and the accuracy of the regression equation was 90.4%. Cement-reinforced screws are recommended when osteoporosis is determined by a combination method.