A Study Evaluating the Performance of Using AI Software and Chest X-rays to Screen for Osteoporosis as Compared to Standard DXA Scans in Patients 50 Years and Older

Inclusion criteria

• Age ≥50 years at the time of chest X-ray
• Availability of

• Posteroanterior (PA) Chest X-ray and
• DXA scan with a valid T-score measurement where both the DXA scan and Chest x-ray examinations were performed within 6 months (182 days) of each other and
• Available X-ray and DXA scans performed on or after 01-Jan-2010.
• Complete metadata (sex and age) available on PACS or hospital records.

Exclusion criteria

• Non-diagnostic Quality or Incomplete Imaging of:

• DXA scan inadequacy: Missing T-score from a technically inadequate scan.
• PA Chest X-ray technical inadequacy: Non-PA projection, significant motion artefacts, inadequate visualisation of thoracic structures, or missing DICOM metadata.
• Image format incompatibility: Non-DICOM format or corrupted image files that would prevent AI analysis
• PA Chest X-ray > ±6 months from the date of the DXA scan.
• Previous diagnosis or treatment of Osteoporosis prior to the DXA scan used in the Study.

• diagnosis of osteoporosis (T-score ≤-2.5), or current/recent anti- osteoporotic medications, within 12 months prior to the DXA scan used in the study.
• Current or recent anti-osteoporotic medications for 3 months (91 days) continuously prior to the Chest x-ray used in the Study.
• Diagnosis of any metabolic bone disease prior to the DXA scan used in the study.
• Diagnosis of metabolic bone disease other than Osteoporosis or Osteopenia, up to a maximum of 3 months (91 days) after the DXA scan.
• Major Chest Wall or Spinal Deformities, including but not limited to:

• Severe structural deformities: Thoracic scoliosis with Cobb angle >40°, severe kyphosis, or chest wall deformities (pectus excavatum/carinatum) affecting >30% of the thoracic cage.
• Surgical hardware: Previous thoracic/spinal surgery with metallic implants obscuring anatomical landmarks required for AI analysis.
• Pathological conditions: Extensive pulmonary consolidation, pleural effusion, lesions or masses obscuring >30% of thoracic skeletal structures
• Subject has opted out of confidential data being used for research purposes