Radiographic Indices for Osteoporosis Screening Using CTI and CCR in Resource-Limited Settings: A Literature Review

Osteoporosis reduces bone integrity, significantly increasing the risk of fractures. This study aims to identify alternative screening methods for assessing osteoporosis in low-income settings, where access to dual-energy X-ray absorptiometry (DXA) is limited. A literature review was conducted, analyzing articles from Google Scholar, PubMed, and institutional libraries published between 2015 and 2025, to identify auxiliary methods for screening for osteoporosis when DXA is not available. Conventional radiographs, when analyzed through the assessment of the Cortical Thickness Index (CTI) and the Calcar-Canal Ratio (CCR), demonstrated high sensitivity and specificity as auxiliary screening tools. However, cutoff values vary significantly among different ethnic populations, indicating the absence of a universal diagnostic standard and underscoring the need for population-specific thresholds. Limited access to DXA worldwide delays early detection of osteoporosis and increases the risk of fragility fractures. Further studies are needed to standardize these metrics in Mexico, which would enable timely diagnosis and treatment in resource-limited settings, thereby improving patient outcomes and quality of life.