Bone Abstracts

Risk factors for osteoporosis are often present among patients referred for diagnostic CT scans. Recent UK Clinical Guidelines (NICE-CG146) promote the initial use of FRAX in the majority of patients at risk of osteoporotic fracture, in any health setting. We gained approval and NHS Innovation funding for a pilot service whereby patients undergoing a routine clinical CT scan of the abdomen or pelvis could be screened by estimating their 10-year fracture risk. Patient and radiographer inconvenience were negligible; the short WHO FRAX questionnaire was simply made available for patients to fill in while waiting for their CT scan. We collected the FRAX questionnaires weekly. In those with moderate/high risk, CT scans were automatically retrieved from the PACS archive for asynchronously-calibrated Mindways BMD analysis, performed on diagnostic CT image sequences already taken. Analysis and reporting was performed semi-automatically by a part-time NHS technician remote from the CT department. Following the analysis, full BMD results and recalculated FRAX+BMD were automatically associated with the CT scan images in the electronic imaging archive (PACS) + medical notes (eMR), along with pre-specified treatment recommendations generated from ‘standard phrases’.

We audited the service against NICE CG146. Our technician was available for 42 days during the pilot during which 119 females aged ≥65 handed in FRAX questionnaires. They had an eligible contrast-free scan type covering their hips and/or spine, no bone-active medication and no prior DXA. A total of 86 women were at risk (72.3%), of whom 69 had satisfactory imaging to permit spine and/or hip bone density estimation. Treatment for osteoporosis was recommended for 11.6% of those patients (eight women); while 88.4% could be reassured (61 women). The CORTEX pathway is simple and feasible without interrupting clinical CT services. We consider that a trial of cost and clinical effectiveness of CORTEX in preventing fragility fracture is warranted.