Abstract

Objective: The aim of this study was to investigate the predictive value of Psoas Muscle Index (PMI) obtained from CT scanning in combination with bone turnover markers for osteoporosis and fracture risk. Methods: This was a retrospective cohort study of 168 postmenopausal female patients from 1 July 2022 to 1 September 2024 who underwent BMD measurement, general biochemical tests, bone turnover markers, and lumbar spine CT, all patients were collected bilateral lumbar masseter cross-sectional area at the level of the patient's L3 vertebrae in lumbar CT and calculated the PMI at L3 level. According to the results of bone mineral density, the population was divided into osteoporosis group (77 cases) and non-osteoporosis group (91 cases). Serum biochemical parameters, bone turnover markers, and lumbar lordosis index were collected from all patients. The general clinical information and the above indicators of the two groups were compared and analyzed. Multiple linear regression was used to investigate the factors affecting BMD values of postmenopausal women. ROC curves were also drawn to analyze and compare the predictive values of PMI, bone turnover markers, and their combinations for osteoporosis and fracture risk. Results: E2 and PMI E2 and PMI were protective factors for lumbar BMD in postmenopausal women, bone turnover marker β -ctx was a risk factor for lumbar BMD in postmenopausal women, and Ca and PMI were protective factors for lumbar BMD in postmenopausal women. Femoral neck BMD and bone turnover marker β -ctx in postmenopausal women are risk factors for lumbar BMD in postmenopausal women. β -ctx, PINP and PMI and their combination indicators are better than β -ctx, PINP and PMI are better than β -ctx, PINP and PMI alone in diagnosing osteoporosis. Similarly, β -ctx, PINP, PMI and their combination were superior to β -ctx, PINP and PMI alone in diagnosing high risk of fracture. Conclusion: The lumbar major muscle index (PMI) and the bone turnover markers β-CTX and PINP have certain predictive value for osteoporosis and fracture in postmenopausal women. In the absence of BMD examination, clinicians can provide clinical guidance to postmenopausal women with abnormal bone mass by calculating the lumbar major muscle index based on previous lumbar CT examination and supplementing it with bone turnover markers to achieve early diagnosis and early treatment.

Keywords: Osteoporosis; Fracture risk; Psoas major index; Bone turnover markers.