ECTS2016 Poster Presentations Osteoporosis: evaluation and imaging (39 abstracts)
University of Cambridge and Addenbrookes Hospital, Cambridge, UK.
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.