Chest CT findings reveal link between vertebral bone density, brain aging
New research suggests that certain CT findings related to bone density may be connected to accelerated cognitive decline and age-related white matter injury.
This, the authors of a new Radiology paper contend, highlights the promise of using routine CT scans to opportunistically assess health metrics beyond bone density alone. Chest CT is routinely performed for things like lung cancer screening, coronary calcium assessment and pulmonary nodule surveillance, but these exams also can be used to extract additional information.
Researchers with Johns Hopkins University conducted a secondary analysis of data from the Multi-Ethnic Study of Atherosclerosis (MESA), incorporating noncontrast chest CT, brain MRI and cognitive testing. The team used a deep learning algorithm developed at Hopkins to calculate thoracic vertebral volumetric bone mineral density from chest CT examinations.
Of nearly 2,100 participants whose CT scans were analyzed, 715 had established bone mineral density measurements and also underwent both brain MRI and cognitive testing. Longitudinal data were available from over 400 participants for assessment of white matter hyperintensity progression and another 400 for changes in white matter microstructure.
The team found that lower baseline vertebral volumetric bone mineral density was associated with a faster decline in global cognition over time. Researchers also identified associations between lower bone density and changes in specific brain regions; lower density was associated with greater accumulation of white matter hyperintensities in the corpus callosum, which is involved in executive functioning, working memory and attention. It also was associated with a steeper decline in total white matter fractional anisotropy in the anterior limb of the internal capsule, another region involved in executive functioning.
“This study is the first longitudinal secondary analysis linking baseline vertebral bone mineral density to changes in white matter structure, white matter hyperintensity progression and cognition,” senior investigator Shadpour Demehri, MD, a professor of radiology at Baltimore-based Johns Hopkins, said in an RSNA news announcement on the findings.
Experts cautioned against interpreting the findings as evidence of a direct relationship between osteoporosis and dementia. Instead, they explained that the association may indicate shared biological processes contributing to both skeletal and brain aging.
“This study is not about cause and effect, but rather the observation of a metabolic syndrome that may cause both bone and brain degeneration,” Demehri said, adding that factors such as insulin resistance, dyslipidemia and menopausal changes could contribute to both processes.
Further research is needed to determine whether incorporating vertebral bone density measurements into clinical workflows can improve risk assessment or patient outcomes, the team noted.
“Diagnostic images contain an immense amount of data that AI can now synthesize at scale across multiple organ systems,” Demehri said. “This creates a robust, newly feasible opportunity to interconnect co-existing age-related pathologies that have traditionally been studied in isolation.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.