Opportunistic Imaging for Osteoporosis Screening: A New Frontier in Fracture Risk Assessment
Opportunistic Imaging for Osteoporosis Screening
Abstract
Osteoporosis remains a major health issue because most people do not realize they have low bone strength until they suffer a fracture. Standard tests like DXA are reliable but not always available or routinely used, which leaves many cases undetected. This has led to growing interest in using imaging that patients are already undergoing for other reasons. These scans often contain valuable information about bone quality, and reviewing them can help flag people at risk long before symptoms appear. Recent work shows that CT scans are particularly useful. Simple measurements such as vertebral Hounsfield Units correlate well with DXA values and can help identify osteopenia or osteoporosis without extra radiation or cost. Dental panoramic films and hand radiographs can also provide clues through cortical thickness and trabecular patterns. MRI adds another dimension by capturing marrow composition and microarchitecture, giving a deeper look at bone health without ionizing radiation. Artificial intelligence is beginning to strengthen this field. Automated tools can measure bone density surrogates, analyze trabecular structure and highlight high-risk patients in routine workflows. These systems can also link with existing hospital software to make screening more efficient. While there are challenges related to standardization, training and workflow adoption, the potential advantages are significant. Opportunistic imaging can turn everyday scans into powerful screening tools, improving early detection and reducing the burden of fractures. As AI develops further and reporting becomes more consistent, this approach could play a central role in closing the diagnostic gap and improving public health outcomes.
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