Criteria for osteoporosis diagnosis: a systematic review and meta-analysis of osteoporosis diagnostic studies with DXA and QCT.

Abstract

This study aims to evaluate the difference between dual-energy X-ray absorptiometry (DXA) <i>vs.</i> quantitative computed tomography (QCT) in the diagnosis of osteoporosis (OP), and to discuss the impact of this difference on OP clinical practice, as well as the potential reasons for the disparities. In this systematic review and meta-analysis (PROSPERO ID: CRD42024599632), we searched Medline, Embase, Scopus, Web of Science, and Cochrane Library databases for studies published from the inception to September 14, 2024. Studies using both QCT and DXA to diagnose OP in the same population were included, and 2 independent reviewers extracted the data by following the PRISMA statement. Pooled odds ratios (ORs) with 95% confidence interval (CI) were estimated using random effects model under heterogeneity. A total of 19 studies with 3939 cases were included. The meta-analysis results indicated that QCT identified significantly more OP patients than DXA in the same population (OR: 4.91, 95% CI: 3.19-7.54; <i>p</i> < 0.0001). Subgroup analysis revealed that the higher diagnostic rate of QCT over DXA in diagnosing OP is significantly stronger in males (OR: 8.45, 95% CI: 3.80-18.77; <i>p</i> < 0.0001) than in females (OR: 2.11, 95% CI: 1.53-2.90; <i>p</i> < 0.0001). Furthermore, among the population aged ≥65 years (OR: 6.01, 95% CI: 3.45-10.47; <i>p</i> < 0.0001), the differences between QCT and DXA in diagnosing OP were significantly greater than those in the population aged <65 years (OR: 2.27, 95% CI: 1.55-3.33; <i>p</i> < 0.0001). The incidence of OP examined by QCT is significantly higher than that of DXA. The different prevalence rates obtained from the two diagnostic techniques will inevitably complicate the prevention and treatment of OP, as well as the selection of cases in drug clinical trials. This study highlighted this confusion and aims to motivate relevant organizations or institutions to address this challenge. There was no funding for this study.