DensityScan
Identifying Osteoporosis before a fracture happens
Hip fractures are devastating for patients and a major source of bed occupancy for the NHS. With appropriate osteoporosis treatment, patients can reduce their risk of hip fracture by 40 to 80%.
Our goal is to help prevent these future hip fractures.
DensityScan provides clinical teams with additional information through wrist X-rays to identify earlier at‑risk patients and support clinical teams in preventing future hospital admissions.
Let’s zoom in on the results of the DensityScan Service Evaluation at the Royal Cornwall Hospitals Trust
- Installed in one acute hospital and two community hospitals
- Using existing wrist X-ray to calculate T-scores without additional radiation exposure
- Patients over age 50 were identified prior to a first fracture , including 3 representative clinical cases
- Automatically flags potential osteoporosis cases, enabling rapid referral to the Fracture Liaison Service for further review
Once a DXA scan and FRAX* assessment are available, NOGG* intervention guidelines can be used to place patients onto the appropriate treatment pathway:
- If below the NOGG intervention threshold → No pharmacological treatment. Provide lifestyle advice and reassurance.
- If above the NOGG intervention threshold → Start osteoporosis treatment
-
If above the NOGG very high risk threshold → Treat and consider a specialist referral
* FRAX: The Fracture Risk Assessment Tool, a validated calculator that estimates a patient’s 10‑year probability of major osteoporotic and hip fractures using clinical risk factors, with or without BMD.
*NOGG: The National Osteoporosis Guideline Group, which provides UK‑wide, evidence‑based guidance on assessing fracture risk and deciding when to start osteoporosis treatment. (See also: NOGG thresholds)
*BMD: Bone Mineral Density
Non-fractured patient case 1
56-year old female referred to radiology after a fall, to check bony tenderness over the lunate and triquetrum.
Young woman at very high risk of hip fracture, who should be considered for a specialist referral.
*MoF: Major osteoporotic fracture
Patient above very high risk intervention threshold.
No bony injury is seen.
T-score at the ultra distal radius was -3.7 and patient was referred for a DXA scan.
DXA found a hip T-score of -1.8 and spine T-score of -1.5.
The FRAX MoF* and hip fractures risks were 14% and 4.4% respectively, presumably due to other clinical risk factors.
Treatment decision pending.
Non-fractured patient case 2
66-year old female referred to radiology due to wrist and right thumb pain for the last two months.
Patient is at risk of hip fracture, she should be treated before her first hospitalization for fracture. Also before she reaches the very high risk threshold and requires a more expensive treatment (approx. 50x more costly).
*The Journal of Clinical Endocrinology & Metabolism, Volume 85, Issue 11, 1 November 2000, Pages 4118–4124, https://doi.org/10.1210/jcem.85.11.6953
Patient above intervention threshold.
Wrist X-ray report noted no acute or previous fracture.
T-score at the distal-third radius was -3.3 and patient was referred for a DXA scan.
DXA found a hip T-score of -1.8 and spine T-score of -2.7.
The FRAX MoF and hip fractures risks were 27% and 6.1% respectively.
Patient was prescribed Alendronate, significantly reducing her future fracture risk by about 50%*
Non-fractured patient case 3
67-year old female fell on outstretched hands several weeks ago, referred to radiology to rule out a carpal bone injury.
Patient showing a risk of fracture very close to the intervention threshold and that should take particular care to her bone health, and at least follow lifestyle advice.
Patient close to intervention threshold.
No fracture demonstrated with x-ray.
T-score at the ultra distal radius was -3.5 and patient was referred for a DXA scan.
DXA found a hip T-score of -2.3 and spine T-score of -1.5.
The FRAX MoF and hip fractures risks were 18% and 3.8% respectively.
Treatment decision pending.
DensityScan turns routine X-rays into an opportunity to diagnose osteoporosis in patients who might otherwise go undetected.