Bone Abstracts

Background: Fracture Liaison Services (FLS) are proven to improve osteoporosis detection for at-risk patients following fragility fracture [1]. However, osteoporosis often remains underdiagnosed when fracture is not present. Evidence suggests reporting clinicians are inconsistent when identifying low bone density from radiographs [2]. IBEX Bone Health (IBEX BH) is a CE-marked software that derives areal bone mineral density (aBMD) from standard wrist radiographs, enabling opportunistic case finding without any adjustment to patient experience during imaging [3]. IBEX BH has been implemented at Royal Cornwall Hospitals Trust (RCHT) as an extension of the FLS pathway.

Methods: Service evaluation of IBEX BH embedded within the FLS at RCHT was performed. IBEX BH was applied to all antero-posterior wrist radiographs in patients aged ≥50 across three radiology sites. Outputs were reviewed alongside radiology reports by the FLS team, with patients identified as high risk referred for DXA and standard clinical assessment, regardless of fracture status. Outcome measures included DXA referral rates, proportion of IBEX BH-flagged patients diagnosed with osteoporosis, and impact on workflow.

Results: Pre-implementation audit data demonstrated only 7.4% of patients aged ≥50 undergoing wrist radiography without fracture were referred for DXA, with 25.6% subsequently diagnosed with osteoporosis or prescribed treatment. Post implementation, 14% of similar patients were referred with an improved diagnostic rate of 64.5%. Integration of IBEX BH into routine radiology workflow required minimal additional administrative burden within FLS processes. Findings suggest both improved identification of patients at risk, and improved efficiency of appropriate DXA referrals. With continued evidence generation validating IBEX BH against DXA in low risk cases, clinical opportunities to reduce unnecessary DXA utilisation have also been identified.

Conclusion: This study represents the first clinical implementation of IBEX BH within routine care. Opportunistic screening embedded within FLS pathways is feasible, with potential to enhance osteoporosis detection and reduce diagnostic delays. Wider adoption may help address the osteoporosis treatment gap, complimenting use of limited DXA resources.

References: 1. Danazumi MS et al. Osteoporosis International. 2024 Jul;35(7):1133-51. https://doi.org/10.1007/s00198-024-07052-1.

2. Vigers W et al. Radiography. 2025 May 1;31(3):102946. https://doi.org/10.1016/j.radi.2025.102946.

3. Meertens R et al. JBMR plus. 2024 Apr 1;8(4):ziae020. https://doi.org/10.1093/jbmrpl/ziae020.