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The increasingly relevant role of CT in predicting
and diagnosing osteoporosis

Dear readers,

The application of CT to musculoskeletal radiological imaging is still a relatively uncovered topic. Nonetheless, CT provides accurate evaluation of several bone diseases, including osteoporosis, where it has recently been shown to be a highly sensitive diagnostic method. 

As illustrated by Dr. Anzidei’s review, proposed in this Newsletter, quantitative CT or the opportunistic use of CT to estimate osteoporosis-related parameters represents a reliable imaging modality, alternative to the standard approach based on dual-energy X-ray absorptiometry. Moreover, several studies have recently demonstrated that new models and indexes combined with CT can increase the technique’s diagnostic performance, allowing physicians to predict osteoporosis in high-risk populations, such as postmenopausal women, and to adopt the appropriate therapeutic strategies, as reported in the papers selected for this Newsletter.

Finally, we propose a clinical case from our archive, where osteoporosis is involved in the differential diagnosis based on the use of the CT.

Suggestions for topics to be covered in future issues of this newsletter are welcome as usual. Please send your ideas to us at

From the team



Assessment of bone density by CT

Analysis by M. Anzidei

Osteoporosis is characterized by a reduction in bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA) is the current standard for the measurement of BMD. Since DEXA has methodological and epidemiological limitations, alternative techniques have been investigated. One particular strategy relies on the opportunistic use of CT scans obtained for unrelated clinical indications.

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Wang P, She W, Mao Z et al. Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies. Skeletal Radiol. 2021 Feb;50(2):371-379.

Gonçalves Koehne de Castro J, Fontenele Carvalho B, Santos de Melo N et al. A new cone-beam computed tomography-driven index for osteoporosis prediction. Clin Oral Investig. 2020 Sep;24(9):3193-3202.

Yasaka K, Akai H, Kunimatsu A et al. Prediction of bone mineral density from computed tomography: application of deep learning with a convolutional neural network. Eur Radiol. 2020 Jun;30(6):3549-3557.

Paggiosi MA, Debono M, Walsh JS et al. Quantitative computed tomography discriminates between postmenopausal women with low spine bone mineral density with vertebral fractures and those with low spine bone mineral density only: the SHATTER study. Osteoporos Int. 2020 Apr;31(4):667-675.



Breast cancer staging
Woman, 65 years old
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