Tackling the osteoporosis crisis by calculating fracture risk from standard digital radiographs
Studies estimate that over 50% of osteoporosis cases go undiagnosed1. IBEX Trueview® addresses this global problem through more widespread identification of patients at risk of fracture, enabling earlier and more targeted intervention.
Osteoporosis is typically only diagnosed through secondary intervention after a debilitating fracture2 resulting in a significant impact on the patient’s quality of life, with many losing their independence and requiring long term care. Hip fractures carry a one-year mortality rate of 33% with half of surviving patients no longer able to walk unaided3. Many of these life-changing fractures could be prevented through adoption of IBEX Trueview® in general radiology.
Trueview generates a measure of projected bone thickness from standard digital radiographs, which is correlated to the DXA-derived areal bone mineral density (aBMD) osteoporosis biomarker. This is used, optionally combined with other risk factors such as age, gender, and medical history, to estimate a patient’s 10-year risk of fracture.
Trueview can be applied opportunistically to scans collected for other diagnostic examinations, increasing case finding and improving decision support for osteoporosis treatment to reduce the risk of more serious future fractures. Trueview is automatically applied to DR scans and is therefore likely to be more widely applied than FRAX, which requires manual input and a suspicion or awareness of osteoporosis.
Immediate clinical benefits include the more effective triage of patients into the rheumatology care pathway to reduce consultation and DXA waiting lists which have extended significantly during the COVID pandemic.
Evidence
The results of a clinical study investigating IBEX Trueview® software as a predictor of bone health were recently published in the British Medical Journal. This demonstrated an impressive AUC of 0.89 with 95% CI [0.84, 0.94] for a non-normal DXA outcome (an aBMD at least one standard deviation below the healthy standard) (figure 2).
Phantom studies demonstrate excellent correlation between Trueview projected bone thickness and CT-derived ground truth, to a level comparable to DXA aBMD (figure 1).
Figure 1 – Trueview projected bone thickness demonstrates a strong correlation to both CT ground truth and DXA aBMD.
Figure 2 – ROC curve for risk predictor model of non-normal DXA outcome AUC=0.89 95% CI [0.843, 0.942] for normal vs osteopenia/osteoporosis
A study is currently underway with Exeter University, UK to confirm performance on patients undergoing routine wrist X-rays.
Clinical Use
IBEX Trueview® is designed to integrate seamlessly into clinical workflow, presenting an incidental finding of 10-year fracture risk within seconds alongside the standard diagnostic radiograph and requiring no radiographer intervention.
Figure 3 – Example of Trueview Bone Health Product Implementation. For illustrative purposes only.
The probability of a 10 year fracture risk (R) and the probability of a T-score < -2.5 (P) generated from an automated region of interest are indicated on the annotated DR scan.
Once in widescale use, opportunistic identification of fracture risk with Trueview is expected to deliver more true positives and fewer false negatives, leading to more patients correctly identified at an earlier stage of disease progression.
The Benefits
A Health Economics Model, audited by York Healthcare Economics Consortium, evidences the effectiveness of introducing Trueview as a decision support tool into the current UK care pathway.
Probabilistic sensitivity analysis showed that this strategy would reduce costs and QALYs in 100% of cases, with an average trust level cost saving of £9.2 million and 1,650 QALYs over the first 20 years as a result of 1,923 fewer fractures and 54 fewer deaths.
Trueview provides decision support to clinicians to ensure that those at highest risk of fracture are identified early. This ground-breaking technology has the enormous potential to reduce the ballooning cost burden on healthcare providers and give our growing and ageing population many more decades of healthy, happy, active life.
If you have any questions about IBEX and its range of X-ray imaging software solutions, please don’t hesitate to get in touch – https://ibexinnovations.co.uk/contact – or visit our website to learn more –
For clinical investigation use only, not for sale in the US and Canada
References
2 – https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/osteoporosis
3 – https://josr-online.biomedcentral.com/articles/10.1186/s13018-019-1226-6