Repository logo
 

Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation.

Accepted version
Peer-reviewed

No Thumbnail Available

Type

Article

Change log

Authors

Maslen, Christina 
Abel, Richard L 
Bhattacharya, Pinaki 
Bromiley, Paul A 

Abstract

Osteoporosis causes bones to become weak, porous and fracture more easily. While a vertebral fracture is the archetypal fracture of osteoporosis, it is also the most difficult to diagnose clinically. Patients often suffer further spine or other fractures, deformity, height loss and pain before diagnosis. There were an estimated 520,000 fragility fractures in the United Kingdom (UK) in 2017 (costing £4.5 billion), a figure set to increase 30% by 2030. One way to improve both vertebral fracture identification and the diagnosis of osteoporosis is to assess a patient's spine or hips during routine computed tomography (CT) scans. Patients attend routine CT for diagnosis and monitoring of various medical conditions, but the skeleton can be overlooked as radiologists concentrate on the primary reason for scanning. More than half a million CT scans done each year in the National Health Service (NHS) could potentially be screened for osteoporosis (increasing 5% annually). If CT-based screening became embedded in practice, then the technique could have a positive clinical impact in the identification of fragility fracture and/or low bone density. Several companies have developed software methods to diagnose osteoporosis/fragile bone strength and/or identify vertebral fractures in CT datasets, using various methods that include image processing, computational modelling, artificial intelligence and biomechanical engineering concepts. Technology to evaluate Hounsfield units is used to calculate bone density, but not necessarily bone strength. In this rapid evidence review, we summarise the current literature underpinning approved technologies for opportunistic screening of routine CT images to identify fractures, bone density or strength information. We highlight how other new software technologies have become embedded in NHS clinical practice (having overcome barriers to implementation) and highlight how the novel osteoporosis technologies could follow suit. We define the key unanswered questions where further research is needed to enable the adoption of these technologies for maximal patient benefit.

Description

Keywords

Osteoporosis, QCT, artificial intelligence, computed tomography, epidemiology, fragility fracture, innovation, screening, technology, vertebral fracture

Journal Title

Ther Adv Musculoskelet Dis

Conference Name

Journal ISSN

1759-720X
1759-7218

Volume Title

13

Publisher

SAGE Publications

Rights

All rights reserved
Sponsorship
Arthritis Research Uk (None)
Arthritis Research Uk (None)
Evelyn Trust (unknown)
National Institute for Health Research (NIHR) (unknown)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Cambridge University Hospitals NHS Foundation Trust (CUH) (A095016 NIHR RfPB)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Royal Osteoporosis Society and NIHR Cambridge Biomedical Research Centre