Can Biomechanical CT Have an Impact in Opportunistic Screening for Osteoporosis?

While dual-energy X-ray absorptiometry (DEXA) is well established for bone mineral density assessment in screening for osteoporosis and ascertaining risk for future fractures, Mary L. Bouxsein, PhD, said access to DEXA can be a formidable obstacle.

“The challenge with DEXA is in some areas there's a long wait to get an appointment. In other areas, there aren't machines and individuals … may live 100 or more miles away from a DEXA scan, so access for different reasons can be limited,” pointed out Dr. Bouxsein in a recent interview with Diagnostic Imaging.

“Less than 25 percent of women who are eligible for DEXA screening actually undergo screening. Some of that is due to the access. I think some of that is due to the awareness. So having more tools that are available for people to get screened for osteoporosis would be beneficial.”

However, biomechanical computed tomography (BCT) may provide a viable alternative. Dr. Bouxsein noted that multiple prospective studies have demonstrated that BCT — advanced analysis of the spine and hip drawn from chest or abdominal CT scans — provides comparable risk fracture assessments to DEXA scans.

It was also recently announced that Medicare will provide national coverage of BCT for bone mass measurement in evaluation for osteoporosis for Medicare beneficiaries starting on October 5, 2026.

Dr. Bouxsein, a past president of the American Society for Bone and Mineral Research, emphasized that the combination of opportunistic screening through widely available CT scans and national coverage from Medicare represents a significant opportunity to bolster screening and early detection of osteoporosis.

“I think there's tremendous potential to really improve upon the number of individuals who are identified earlier and can be encouraged to either make lifestyle changes to improve their bone health, and or, if their disease is severe enough, be considered for one of the available treatments,” posited Dr. Bouxsein, the Maurice E. Mueller Professor of Orthopedic Surgery at Harvard Medical School.

(Editor’s note: For related content, see “FDA Clears AI-Powered Bone Mineral Density from Abdominal CT Scans,” “Emerging CT Research Suggests Possible Correlation Between Subclinical Emphysema and Vertebral Bone Loss” and “Can AI Facilitate Improved Dual-Energy X-Ray Screening for Patients at High Risk of Osteoporosis?”)