{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T21:32:26Z","timestamp":1793741546372,"version":"4.6.1"},"reference-count":70,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This retrospective observational cohort examined whether opportunistic CT-derived Hounsfield units (HU) of the lumbar spine and proximal femur together with serum 25-OH-vitamin D can predict sacral insufficiency fractures (SIF) and osteoporosis. No interventional procedures were performed. Methods: Consecutive suspected SIF cases over 3 years (n = 253) were assigned to SIF (n = 98) or controls without SIF or spine\/hip fractures (n = 155). HU were measured using ellipsoidal ROIs at L1\u2013L3 and an irregular area ROI across the entire proximal femoral cancellous bone; vitamin D was quantified; ROC analyses assessed discrimination. HU cut-points were referenced via HU-to-QCT\/CTXA conversions. Results: SIF patients had markedly lower HU than controls (lumbar 44.84 vs. 105.66 HU; femoral 47.0 vs. 148.0 HU). Diagnostic performance was excellent (AUC 0.98 for SIF discrimination using lumbar HU; AUC 0.98 for osteoporosis prediction using femoral HU). Vitamin D deficiency (&lt;20 ng\/mL) was highly prevalent (92.9%) with lower means in SIF (3.72 vs. 8.24 ng\/mL). Within SIF, patients with hip fracture had femoral HU \u2248 14.2 vs. 70.6 without hip fracture; effect sizes were very large. Conclusions: Opportunistic HU assessment from routine CT provides a rapid, reproducible surrogate of bone density that distinguishes SIF with near-perfect accuracy and identifies osteoporosis. HU thresholds around ~96\u201398 are consistent with osteoporotic ranges and can be implemented to trigger metabolic evaluation and early osteoanabolic therapy where appropriate.<\/jats:p>","DOI":"10.3390\/diagnostics15222926","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"2926","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic Value of Opportunistic CT-Based Bone Density Assessment in Patients with and Without Sacral Insufficiency Fractures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1385-2793","authenticated-orcid":false,"given":"Julian Ramin","family":"Andresen","sequence":"first","affiliation":[{"name":"Division of Orthopaedics, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, W\u00e4hringer G\u00fcrtel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9953-3987","authenticated-orcid":false,"given":"Guido","family":"Schr\u00f6der","sequence":"additional","affiliation":[{"name":"Clinic for Orthopaedics and Trauma Surgery, Sana Hospital Bad Doberan, Academic Teaching Hospital of the University of Rostock, Am Waldrand 1, 18209 Hohenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-8453","authenticated-orcid":false,"given":"Thomas","family":"Haider","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, W\u00e4hringer G\u00fcrtel 18-20, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christof","family":"Schober","sequence":"additional","affiliation":[{"name":"Practice for Orthopaedics and Osteology, OrthoCoast, Hufelandstra\u00dfe 1, 17438 Wolgast, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1575-525X","authenticated-orcid":false,"given":"Reimer","family":"Andresen","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology\/Neuroradiology, Westk\u00fcstenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck und Hamburg, Esmarchstra\u00dfe 50, 25746 Heide, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"ref_1","first-page":"882","article-title":"Sacral Insufficiency Fractures in the Elderly","volume":"76","author":"McGuigan","year":"1994","journal-title":"J. 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