{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:41:15Z","timestamp":1772692875471,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"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: Local bone quality of the proximal humerus is a key determinant of fracture risk and implant stability in osteoporotic bone. Beyond established HU-based calibration, CT-osteoabsorptiometry (CT-OAM)-derived indices and microarchitecture-oriented workflows warrant systematic cross-modality evaluation. Methods: Twelve proximal humeral heads from six body donors (age 65\u201386 years; bilateral specimens) were analyzed using paired clinical CT and high-resolution micro-CT. Bone quality was quantified by (i) a HU-calibrated cancellous vBMD method (Krappinger et al.), (ii) a CT-OAM-inspired workflow reporting an ROI-averaged mean-intensity index in arbitrary units (a.u.), and (iii) a calibrated Bone Microarchitecture Analysis (BMA) workflow in Analyze 15.0. Paired tests, linear regression, and repeated-measures ANOVA after z-standardization were applied. Results: HU calibration yielded a mean trabecular vBMD of 114.37 \u00b1 35.15 mg\/cm3 on clinical CT. The BMA workflow produced higher CT-based values (207.37 \u00b1 23.78 mg\/cm3, p &lt; 0.001) and markedly higher micro-CT values (469.34 \u00b1 30.99 a.u.), indicating a systematic level shift between calibration frameworks. The CT-OAM index averaged 166.94 \u00b1 40.12 a.u. on clinical CT and 455.89 \u00b1 132.63 a.u. on micro-CT. Cross-modality agreement was very strong for CT-OAM (R2 = 0.888) and moderate for BMA (R2 = 0.502). After z-standardization, no significant differences were detected between the three CT-based approaches. Conclusions: A CT-OAM-inspired ROI-mean index and a BMA-based workflow provide complementary, transferable readouts of proximal humeral bone quality across clinical CT and micro-CT, with stronger cross-modality rank consistency for CT-OAM. Absolute density values differ systematically between calibration frameworks and should not be interpreted as directly interchangeable. These approaches support opportunistic, site-specific bone quality assessment from routine CT, but require prospective validation against fixation-related outcomes and robust scanner-independent standardization.<\/jats:p>","DOI":"10.3390\/diagnostics16050756","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:18:45Z","timestamp":1772554725000},"page":"756","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Assessment of Proximal Humeral Bone Density Using CT Osteoabsorptiometry, Bone Microarchitecture Analysis, and a HU-Based Calibration Method: A CT and Micro-CT Study in Elderly Body Donors (65\u201386 Years)"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4134-817X","authenticated-orcid":false,"given":"Susanne","family":"Strasser","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenz","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Kampik","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohit","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-213X","authenticated-orcid":false,"given":"Johannes Dominikus","family":"Pallua","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Medical University Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/BF03350919","article-title":"Bone microarchitecture as an important determinant of bone strength","volume":"27","author":"Giannini","year":"2004","journal-title":"J. Endocrinol. Investig."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00223-001-1058-2","article-title":"Bone microarchitecture and bone fragility in men: DXA and histomorphometry in humans and in the orchidectomized rat model","volume":"69","author":"Audran","year":"2001","journal-title":"Calcif. Tissue Int."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Migliorini, F., Giorgino, R., Hildebrand, F., Spiezia, F., Peretti, G.M., Alessandri-Bonetti, M., Eschweiler, J., and Maffulli, N. (2021). Fragility Fractures: Risk Factors and Management in the Elderly. Medicina, 57.","DOI":"10.3390\/medicina57101119"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s43465-024-01316-y","article-title":"Fixation Failure in Osteoporotic Bone: A Review of Complications and Outcomes","volume":"59","author":"Mukhopadhaya","year":"2025","journal-title":"Indian J. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.2106\/JBJS.I.00879","article-title":"Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases","volume":"92","author":"Kamerlink","year":"2010","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.2106\/JBJS.J.00869","article-title":"Pulsed electromagnetic field stimulation for acute tibial shaft fractures: A multicenter, double-blind, randomized trial","volume":"93","author":"Adie","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1302\/0301-620X.83B4.0830565","article-title":"The cross-sectional area of supraspinatus as measured by diagnostic ultrasound","volume":"83","author":"Katayose","year":"2001","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s11914-025-00945-y","article-title":"Osteoporotic Fractures of the Proximal Humerus: An In-Depth Review of Current Management Options","volume":"23","author":"Girgin","year":"2025","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","article-title":"Epidemiology of proximal humerus fractures","volume":"16","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jseint.2021.12.003","article-title":"Proximal humerus fractures: Epidemiology and trends in surgical management of hospital-admitted patients in Portugal","volume":"6","author":"Linhares","year":"2022","journal-title":"JSES Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s12178-023-09853-z","article-title":"Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement","volume":"16","author":"Foruria","year":"2023","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s13018-017-0639-3","article-title":"Current concepts in locking plate fixation of proximal humerus fractures","volume":"12","author":"Laux","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5676","DOI":"10.21037\/qims-22-927","article-title":"Quantification of bone quality and distribution of the proximal humerus with dual-energy computed tomography","volume":"13","author":"Yu","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2151458517750516","DOI":"10.1177\/2151458517750516","article-title":"Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient","volume":"9","author":"Schumaier","year":"2018","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_15","first-page":"70","article-title":"Bone densitometry--the gold standard for diagnosis of osteoporosis","volume":"61","author":"Punda","year":"2014","journal-title":"Reumatizam"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jocd.2017.06.014","article-title":"Dual-energy X-ray Absorptiometry","volume":"20","author":"Jain","year":"2017","journal-title":"J. Clin. Densitom."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.bone.2017.01.033","article-title":"Quality in dual-energy X-ray absorptiometry scans","volume":"104","author":"Morgan","year":"2017","journal-title":"Bone"},{"key":"ref_18","first-page":"e26518","article-title":"Osteoporosis Screening and Fracture Risk Assessment Tool: Its Scope and Role in General Clinical Practice","volume":"14","author":"Chavda","year":"2022","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"743","DOI":"10.2106\/JBJS.I.00919","article-title":"The assessment of fracture risk","volume":"92","author":"Unnanuntana","year":"2010","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3390\/osteology4020007","article-title":"Reliability of Measuring the Proximal Humeral Bone Mineral Density Using Dual-Energy X-ray Absorptiometry","volume":"4","author":"Kamiyama","year":"2024","journal-title":"Osteology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1056\/NEJMra053077","article-title":"Bone quality--the material and structural basis of bone strength and fragility","volume":"354","author":"Seeman","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2554930","DOI":"10.1080\/07853890.2025.2554930","article-title":"Osteoporosis screening and major osteoporotic fracture prediction by cranial computed tomography-derived Hounsfield units: A multi-center study on opportunistic osteoporosis screening","volume":"57","author":"Desch","year":"2025","journal-title":"Ann. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00256-011-1174-7","article-title":"Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data","volume":"41","author":"Krappinger","year":"2012","journal-title":"Skelet. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1007\/BF00351749","article-title":"Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints","volume":"18","author":"Putz","year":"1989","journal-title":"Skelet. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1002\/jbmr.141","article-title":"Guidelines for assessment of bone microstructure in rodents using micro-computed tomography","volume":"25","author":"Bouxsein","year":"2010","journal-title":"J. Bone Miner. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4103\/ortho.IJOrtho_243_17","article-title":"Complications Associated with Locking Plate of Proximal Humerus Fractures","volume":"52","author":"Kavuri","year":"2018","journal-title":"Indian J. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11657-015-0209-4","article-title":"Epidemiology of proximal humerus fractures","volume":"10","author":"Launonen","year":"2015","journal-title":"Arch. Osteoporos."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2106\/JBJS.I.01505","article-title":"Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly","volume":"93","author":"Bell","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/01.blo.0000194672.79634.78","article-title":"Update in the epidemiology of proximal humeral fractures","volume":"442","author":"Palvanen","year":"2006","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/j.jse.2013.02.003","article-title":"Locking plate fixation of proximal humeral fractures with impaction of the fracture site to restore medial column support: A biomechanical study","volume":"22","author":"Weeks","year":"2013","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.ecl.2015.05.002","article-title":"Bone Health and Osteoporosis","volume":"44","author":"Lupsa","year":"2015","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2106\/JBJS.J.00160","article-title":"Hounsfield units for assessing bone mineral density and strength: A tool for osteoporosis management","volume":"93","author":"Schreiber","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.2106\/JBJS.N.01230","article-title":"Opportunistic Osteoporosis Screening\u2014Gleaning Additional Information from Diagnostic Wrist CT Scans","volume":"97","author":"Schreiber","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1093\/jbmr\/zjae143","article-title":"Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts","volume":"39","author":"Sarfati","year":"2024","journal-title":"J. Bone Miner. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/s00198-021-05999-z","article-title":"The clinical application of high-resolution peripheral computed tomography (Micro-CT) in adults: State of the art and future directions","volume":"32","author":"Szulc","year":"2021","journal-title":"Osteoporos. Int."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/756\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T05:26:09Z","timestamp":1772688369000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16050756"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16050756","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]}}}