By Mary Henderson
Using routine X-rays and AI-based software, a Toronto academic hospital demonstrated the benefit of opportunistically identifying patients over the age of 50 with low bone mineral density (BMD) for the early detection of often-overlooked osteoporosis.
“Osteoporosis is a silent disease that can lead to pain, restricted activity, fractures, and increased health care costs,” said Andrew Jayarajah, MBBS, research coordinator at the Sunnybrook Research Institute in Toronto.
The current standard for diagnosis of osteoporosis and low BMD is a clinical review of a patient’s history and referral for dual-energy X-ray absorptiometry (DXA), if appropriate. However, DXA screening rates are very low in Canada according to Dr. Jayarajah
His team investigated the clinical adoption of Rho, an AI-based software device that automatically analyzes standard X-rays at the time of acquisition and assigns a score from 1-10. A positive Rho score (DXA T-score < -1 at either/both the femoral neck or L1-L4) correlates with the likelihood of having low BMD and risk for bone fracture.
The radiologist can choose to include the score in their imaging report and the referring providers can utilize the Rho score to conduct their own fracture risk assessment, including ordering a DXA scan.
Patients awaiting an X-ray exam at Sunnybrook Health Sciences Centre were asked to participate in the Rho screening. Eligible subjects included patients over the age of 50 having a frontal X-ray of the lumbar or thoracic spine, chest, pelvis, hand/wrist or knee.
The study cohort of 985 (563 females, age 50-97) subjects had X-ray exams analyzed by the AI tool and completed a questionnaire. Most radiologists reading the X-rays included the Rho finding in their reports.
Of the 985 subjects, 589 (80% of women and 48% of men) had a positive Rho score; 130 went on to have a follow up DXA scan. Of the Rho-triggered DXAs, 59% of females and 33% of males were determined to be at moderate to high fracture risk.
“The Rho finding provided a chance for prevention or treatment strategies to be introduced earlier than they may have otherwise,” Dr. Jayarajah said. “Some of the patients who underwent a DXA scan and had low BMD had never discussed bone health with their doctor, suggesting the Rho finding initiated the often-overlooked screening processes.”
Family physicians of patients with a positive Rho score were asked to rate the effectiveness of the AI tool and provide feedback. Of the survey’s 51 respondents, 78% believed Rho was beneficial for patient care and 74% said they would use Rho screening information.
“Opportunistic screening for low BMD with Rho has the potential to help address low screening rates for fracture risk and osteoporosis,” he concluded. “This screening tool can identify patients at risk for low BMD in a real clinical setting.”
Access the presentation, “Opportunistic Screening of Low Bone Density on X-Ray. Experience at an Academic Hospital,” (W1-SSNPM03-2) on demand at RSNA.org/MeetingCentral.
© 2024 RSNA.
The RSNA 2024 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, December 1 — Friday, December 6.
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