PHOENIX (Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays): protocol for...

Area of Science:

• Radiology and Imaging
• Bone Health and Osteoporosis
• Public Health Interventions

Background:

• Millions of routine diagnostic CT scans in the UK involve the thoracolumbar spine or pelvis.
• A significant proportion of these scans reveal undiagnosed osteoporosis or vertebral fractures.
• Early detection and management of osteoporosis are crucial for preventing debilitating fractures.

Purpose of the Study:

• To evaluate the feasibility of the PHOENIX intervention for early osteoporosis detection using existing CT scans.
• To assess the potential of PHOENIX to increase osteoporosis and vertebral fracture identification rates.
• To determine if PHOENIX improves osteoporosis treatment rates compared to standard care.

Main Methods:

• A multicentre, randomized, pragmatic feasibility study involving patients aged 65+ (women) or 75+ (men) undergoing CT scans.
• Participants were randomized to the PHOENIX intervention, active control (FRAX questionnaire), or usual care.
• The PHOENIX intervention involved CT scan analysis for bone density and vertebral fractures, with GP reporting.

Main Results:

• The study aims to randomize 375 patients within 10 months and achieve 75% retention.
• Secondary outcomes include osteoporosis/vertebral fracture identification and treatment rates at 1 year.
• Predicted treatment rates: 20% for PHOENIX, 16% for active control, and 5% for usual care.

Conclusions:

• The PHOENIX intervention offers a novel approach to identify osteoporosis and fractures from routine CT imaging.
• Feasibility will be determined by patient recruitment, retention, and successful implementation of the intervention.
• Successful implementation could lead to improved early detection and management of osteoporosis in a large patient cohort.