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The association of paraspinous muscle size and density and T12 vertebral bone mineral density and mortality in older adults

Principal Investigator
Name
Leon Lenchik
Degrees
MD
Institution
Wake Forest School of Medicine
Position Title
Professor of Radiology
Email
About this CDAS Project
Study
NLST (Learn more about this study)
Project ID
NLST-223
Initial CDAS Request Approval
Jun 7, 2016
Title
The association of paraspinous muscle size and density and T12 vertebral bone mineral density and mortality in older adults
Summary
Sarcopenia and osteopenia has been inconsistently associated with mortality in various trials. Some of the inconsistency stems from differing imaging approaches used to assess sarcopenia and osteopenia, including CT, MRI, and DXA. The advantage of assessing sarcopenia using CT is that it allows for measurement of muscle quantity (e.g., size) and muscle quality (e.g., muscle density as a measure of fatty infiltration. The advantage of assessing osteopenia using CT is that (unlike DXA) it allows for a volumetric bone mineral density (BMD) measurement. We have recently applied this methodology to a cohort of elderly hip fracture patients and showed an association between decreased paravertebral muscle size and density and increased mortality. Other investigators have shown an association of CT measured volumetric BMD and mortality. Our objective is to apply this methodology to baseline and 2-year CT exams of subjects in the NLST aged 70 years and older, to determine if an association exists between muscle and bone metrics and mortality.
Aims

The archived cases from the National Lung Screening Trial includes low-dose CT scans from approximately 2352 subjects, age 70-74. Approximately 20- 25% of the cohort died during the course of the trial. This large cohort will allow us to investigate both cross sectional and longitudinal muscle and bone metrics and to determine if these metrics can be used to predict mortality.

Hypothesis Aim 1: Baseline CT measurement of muscle size is associated with mortality.
Approach Aim 1: We will measure paraspinous muscle size on baseline CT images at the level of T12 vertebra and determine the association with mortality. Secondary analysis will examine the effect of covariates such as self-reported activity level.
Hypothesis Aim 2: Baseline CT measurement of muscle density is associated with mortality.
Approach Aim 2: We will measure paraspinous muscle density on baseline CT images at the level of T12 vertebra and determine the association with mortality. Secondary analysis will examine the effect of covariates such as self-reported activity level.
Hypothesis Aim 3: Baseline CT measurement of BMD is associated with mortality.
Approach Aim 3: We will measure volumetric trabecular BMD on baseline CT images at the level of T12 vertebra and determine the association with mortality. Secondary analysis will examine the effect of covariates such as self-reported activity level.
Hypothesis Aim 4: Change in muscle size, muscle density, and BMD is associated with mortality.
Approach Aim 4: We will measure muscle size, muscle density, and BMD at the level of T12 vertebra on CT exams at year 2. We will determine the association of the change in the muscle and bone measures from baseline with mortality.

Collaborators

Caroline Chiles, MD., Wake Forest School of Medicine
Joel Stitzel, Ph.D., Wake Forest School of Medicine
Ashley Weaver, Ph.D., Wake Forest School of Medicine
Haiying Chen Ph.D., Wake Forest School of Medicine
Robert Boutin, MD., University of California, Davis
Barton L Wise, MD., University of California, Davis

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