Fractures and mortality prediction by opportunistic screening of osteoporosis

Roux, C; Rozes, A; Ajrouche, A; Taright, N; Reizine, D; Zemouri, S; Hajage, D; Tubach, F

doi:10.1007/s00198-026-08270-5

Osteoporosis & bone health

Fractures and mortality prediction by opportunistic screening of osteoporosis

Osteoporos IntPublished 30 Oct 2026Multicentre observational retrospective cohort study

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Authors' conclusion

Fully automated opportunistic screening, predicted incident osteoporotic fractures necessitating hospitalization and mortality over 3 years in patients aged 60 or older with an inpatient computed tomography scan involving the lumbar spine for any indication.

Study context

Population: Patients aged 60 or older with an inpatient CT scan involving the lumbar spine for any indicationpatients included (75.3 ± 9.3 years old)
Participants: 46,219 patients

Predictors: Age, sex, bone score, and detection of a prevalent lumbar vertebral fractures (VF)
Predicted outcome: first occurrence of osteoporotic fracture necessitating hospitalization (OFNH); death

Methodological details3-year follow-up, fully automated procedure

3-year follow-up
Fully automated procedure

Model performance

As reported in the abstract

3 years

Area under the ROC curve

Model predicting any OFNH

0.68(0.67 to 0.69)

Model predicting hip fractures

0.71(0.70 to 0.71)

Secondary outcomes

Outcome	← Lower with lumbar VF detected ←→ Higher with lumbar VF detected →	Estimate
Incident OFNH by prevalent lumbar VF on the index scanLumbar VF detectedvs No lumbar VF detected	0.20.5125	sub-hazard ratio, any incident OFNH 2.22 (CI 2.06–2.39)
Incident OFNH by prevalent lumbar VF on the index scanLumbar VF detectedvs No lumbar VF detected	0.20.5125	sub-hazard ratio, non-vertebral 2.18 (CI 2.02–2.38)
Incident OFNH by prevalent lumbar VF on the index scanLumbar VF detectedvs No lumbar VF detected	0.20.5125	sub-hazard ratio, hip 2.34 (CI 2.09–2.63)
Incident OFNH by prevalent lumbar VF on the index scanLumbar VF detectedvs No lumbar VF detected	0.20.5125	sub-hazard ratio, VF 3.29 (CI 2.45–4.4)
3-year mortality by prevalent lumbar VFLumbar VF detectedvs No lumbar VF detected	0.20.5125	adjusted hazard ratio 1.29 (CI 1.25–1.34)
	0.20.5125Ratio (log scale)

Baseline bone score and prevalent lumbar VF

Mean bone score: 127.4 ± 75.2 HU
Prevalent lumbar VF detected: 27.3%

Crude incidence of OFNH and mortality · 3-year

OFNH: 6.8%
Mortality: 27.9%

Original publication

Fractures and mortality prediction by opportunistic screening of osteoporosis. Osteoporos Int. Published 30 October 2026. doi:10.1007/s00198-026-08270-5

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