Screening for osteoporosis may soon take a significant leap forward, thanks to innovative research led by Torkel Brismar, a radiologist and professor at the Department of Clinical Science, Intervention and Technology – CLINTEC. His studies suggest that mammography, typically used for breast cancer screening, can also detect early signs of fragile bones, potentially preventing future fractures.
Osteoporosis is often referred to as a “silent disease,” as it initially presents no symptoms. Early detection is crucial, particularly for individuals aged between 55 and 70, who are at higher risk for spinal and hip fractures. Torkel Brismar emphasizes the importance of early intervention. “Early treatment offers significant benefits,” he states, highlighting the urgency of identifying at-risk patients before they experience their first fracture.
In a groundbreaking study, Brismar and his team examined over 8,000 patients who had hand X-rays between 2000 and 2008. These patients either sought emergency care for suspected fractures or were referred by rheumatologists. The researchers assessed bone density in specific bones of the hand and tracked the patients over time using health registers. This approach enabled them to identify individuals who later sustained hip fractures, providing insight into how hand X-rays can predict future fracture risks.
Innovative Screening Approach with Mammography
The next phase of the research involved inviting women to participate in additional imaging during their mammography appointments. After their breast examinations, the participants, totaling 14,000 women, placed their hands on the mammography machine for a brief additional image, a process that takes just a few seconds. Each participant also completed a questionnaire detailing risk factors for osteoporosis, such as recent falls and mobility issues.
The results indicated a clear correlation between bone density in the hand and fractures associated with osteoporosis. Despite the low number of hip fractures observed—attributable to the relatively young average age of participants, which was 53, and a follow-up period of just over three years—the findings are encouraging. “Based on specific values in the bones of the hand, we can predict the risk of hip fracture within a defined timeframe,” Brismar explains. “It seems feasible to screen for osteoporosis alongside mammography or when hand X-rays are performed for other reasons.”
Future Directions in Osteoporosis Detection
Researchers are now conducting a long-term follow-up on the women who had their hands X-rayed nearly two decades ago. This follow-up aims to determine how frequently bone density measurements should be repeated to identify as many cases of osteoporosis as possible.
In addition to this ongoing research, another project is underway where researchers are training an artificial intelligence system to detect osteoporosis in CT scans taken during abdominal examinations. This advancement opens the door to a more comprehensive assessment of fracture risk. As Brismar notes, fracture risk is not solely determined by bone density; factors such as muscle mass and body fat also play a critical role in the likelihood of falls and subsequent injuries.
Some patients may benefit from interventions beyond medication that primarily targets bone strength. Strategies could include targeted muscle training, the use of protective garments, and other tailored interventions.
The potential for detecting osteoporosis through existing screening methods could revolutionize how healthcare providers assess and manage bone health, ultimately leading to better outcomes for at-risk populations.
