Predicting fractures and pain using chest x-rays

For many older patients—and some younger ones—a fracture marks the beginning of the end. The fracture itself is seldom fatal; but it sets off a downward spiral of pain, decreased mobility, physical deconditioning, debility, and ultimately death. This is why screening for osteoporosis, recommended today for women starting at age 65, is so critical: the appearance of bones on a special type of x-ray (called a DEXA scan) shows us who is at high risk of fractures, and lets us start treatments to prevent them before they happen. Given the massive costs of fractures—to both patients, and the health care system, which a recent report put at nearly $60 billion for fractures in US Medicare patients alone—it’s clear that our current screening strategies are not adequate. For one thing, despite established guidelines calling for universal screening over age 65, the vast majority of women don’t get it—not to mention the fact that many fractures occur in men and younger people, for whom guidelines don’t recommend screening. So it would be very useful to find another way to predict fractures at scale, using routinely available data. The chest x-ray is, by far, the most commonly-performed radiological study in the world, done when patients see their doctor for a cough, chest or back pain, before surgery, in the ER, on admission to the hospital, and in a variety of other settings. An interesting fact about the ‘chest’ x-ray is that it also gets a very clear view of the spine, from neck to the upper lumbar area. And the spine is an excellent place to assess the quality and quantity of bone, which may hold signal for predicting future fractures.