Endocrine Abstracts

Background: Osteoporosis (OP) is underdiagnosed and frequently left untreated. CT derived bone mineral density (BMD) and identification of vertebral compression fracture (VCF) on CT done for another indication are 2 new artificial intelligence (AI) based techniques for opportunistic diagnosis of OP. Our aim was to assess the clinical impact of opportunistic diagnosis of OP

Methods: This retrospective study included men and women over age 50, insured by Clalit HMO, who underwent a CT scan for any reason at our institution and were identified by NanoxAI software as having a VCF in one or more vertebrae. Patients were excluded if a radiologist did not confirm the VCF, had a prior diagnosis of a motor vehicle accident (MVA), multiple myeloma, or spinal metastases. CT-derived BMD was calculated using Hounsfield units (HU) and when available results of DXA-BMD were retrieved. Demographic, clinical, and biochemical data including medication purchase were collected from the electronic medical records.

Results: In a 4 months period, one hundred and fifty-one patients with VCF met the inclusion and exclusion criteria, of which only 71 (47%) had a prior diagnosis of osteoporosis. Of the 71 patients with prior diagnosis of OP only 12.7% purchased any OP medication in the 2 years prior to the index CT. Patients without a prior diagnosis of osteoporosis were younger (mean age 73.02 vs. 77.27; P=0.016) and had higher rates of male gender (58.8 vs. 26.8%; P<0.001). Ethnicity and marital status were similar in both groups as were rates of prior diagnosis of diabetes mellitus and rheumatoid arthritis. Twenty-five-dihydroxy vitamin D levels were higher and alkaline. phosphate levels were lower in patients with a prior diagnosis of OP (69.25 vs. 53.29 nmol/l; P=0.038), and (101 vs. 78 U/l; P=0.025) respectively. Only 28% of the cohort underwent BMD-DXA scans in the 4 years prior to the index CT; T scores were significantly lower in the group with prior diagnosis of OP in spine (-0.29 vs. -2.22; P<0.001), femur neck (-1.66 vs. -2.42; P=0.009) and total hip (-1.18 vs. -2.3; P=0.004). while CT derived BMD equivalents were similarly low in both groups with VCF irrespective of prior diagnosis of OP (95.05 vs. 90.33 HU P=0.540).

Conclusion: Our results highlight the underdiagnosis and the treatment gap in osteoporosis which was significantly higher in men. Routine opportunistic diagnosis of OP by AI is feasible and will contribute to improved diagnosis and treatment of OP.