Sex-specific skeletal ageing trajectories and reference centiles across vertebrae and ribs in over 78,000 patients

Automated non-contrast CT attenuation declines with age across 49 vertebra and rib sites, with sex-dependent trajectories in 78 620 Japanese patients.

• Why it matters: Age-related bone loss is known, but CT attenuation trajectories across the whole skeleton and whether any site can substitute for L1 are not well defined.
• What they did: Using TotalSegmentator v2.10.0 on 2024 torso CT from nine Japanese academic hospitals, the study fit sex-specific spline mean curves and quantile-regression centiles for 25 vertebrae and 24 ribs, testing sex-by-age interactions and L1 surrogate performance.
• The result: Women showed steeper decline than men (median 52.0 years; 40–80-year change median -34.1% vs -12.8%), and L2 matched L1 closely (limits of agreement ±45 HU) whereas ribs did not (±68 to ±82 HU).

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