OTDOncology Treatment Discovery3083-49962981-8079Bio-Byword Scientific Publishing Pty. Ltd.10.26689/otd.v4i2.14225ArticleOpportunistic CT Screening for Osteoporosis in Postmenopausal Women: Background, Challenges, and Evidence Gapshttps://artdesignp.com/journal/OTD/4/2/10.26689/otd.v4i2.14225ZhongShiyu,ZhengTing,YangLiuqing,DengXiangrong,HanBangcai,YeSuting,LiWenmin,WuYinghua2026422026-06-30Postmenopausal women represent the highest-risk population for osteoporosis (OP), with a prevalence exceeding 32.5%. The resultant fragility fractures are associated with devastating disability, mortality, and a substantial socioeconomic burden. Dual-energy X-ray absorptiometry (DXA), the diagnostic gold standard, is insufficient for large-scale screening due to limited equipment availability, low screening coverage, and poor awareness. Opportunistic screening using CT attenuation values (Hounsfield Units, HU) from routine scans has emerged as a promising alternative, offering the potential for widespread without additional radiation or cost. However, translating this strategy to the core target population of postmenopausal women reveals three critical evidence gaps: (1) a lack of genetic causal evidence specific to postmenopausal women, making it difficult to establish a definitive link between HU decline and osteoporosis; (2) high heterogeneity in diagnostic studies, with a lack of pooled diagnostic parameters exclusive to this group, potentially leading to misclassification with existing general-population thresholds; and (3) the absence of a screening model built entirely on literature parameters from postmenopausal women, hindering individualized risk stratification. This review systematically examines the disease burden of OP in postmenopausal women, the limitations of DXA screening, the principles and progress of opportunistic CT, and critically analyzes these three key gaps to underscore the necessity and urgency for a comprehensive chain of evidence, from causal mechanisms to clinical application.

Ardelean A, Tit DM, Furau R, et al., 2025, Beyond Bone Mineral Density: Real-World Fracture Risk Profiles and Therapeutic Gaps in Postmenopausal Osteoporosis. Diagnostics, 15(15): 1972.

Zhao W, Wu Q, Liu Q, et al., 2025, Government-Implemented Population Osteoporosis Screening in Rural China: Achieving Universal Coverage with Portable DXA. BMC Geriatrics, 25(1): 815.

Zeng Q, Li N, Wang Q, et al., 2019, The Prevalence of Osteoporosis in China, A Nationwide, Multicenter DXA Survey. Archives of Osteoporosis, 14(1): 39–48.

Kanis JA, Cooper C, Rizzoli R, et al., 2019, European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women. Osteoporosis International, 30(1): 3–44.

Özmen S, Kurt S, Timur HT, et al., 2024, Prevalence and Risk Factors of Osteoporosis: A Cross-Sectional Study in a Tertiary Center. Medicina, 60(12): 2109.

Heaton TB, Behrens NF, Eyring JB, et al., 2026, Language Barriers as a Driver of Health Disparity in Bone Density Screening Among the Aging Population. American Journal of Preventive Medicine, 70(5): 108263.

Hans D, Hartl F, Krieg M, 2020, Quantitative Ultrasound for Osteoporosis Detection: A Meta-Analysis. Journal of Bone and Mineral Research, 35(9): 1677–1684.

Pongchaiyakul C, Songpattanasilp T, 2024, Barriers to Osteoporosis Care in Rural Thailand. Archives of Osteoporosis, 19: 12.

Pickhardt PJ, Pooler BD, Lauder T, et al., 2013, Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications. Annals of Internal Medicine, 158(8): 588–595.

Majumdar SR, Leslie WD, 2013, Conventional Computed Tomography Imaging and Bone Mineral Density: Opportunistic Screening or “Incidentaloporosis”? Annals of Internal Medicine, 158(8): 630–631.

Vermue H, Garibaldi R, Alshoaibi Y, et al., 2025, Opportunistic CT-Based Osteoporosis Screening of the Hip: A Systematic Review of Diagnostic Accuracy. Archives of Orthopaedic and Trauma Surgery, 145(1): 506.

Gausden EB, Nwachukwu BU, Schreiber JJ, et al., 2017, Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment: A Qualitative Systematic Review. Journal of Bone and Joint Surgery American Volume, 99(18): 1580–1590.

Zhu Y, Triphuridet N, Yip R, et al., 2021, Opportunistic CT Screening of Osteoporosis on Thoracic and Lumbar Spine: A Meta-Analysis. Clinical Imaging, 80: 382–390.

UK Biobank, 2025, Mapping the Role of Macro and Micronutrients in Bone Mineral Density: A Comprehensive Mendelian Randomization Study. UK Biobank, London.

Scientific Reports, 2025, MR Analysis Reveals No Causal Association Between Mitochondrial DNA Copy Number and Osteoporosis. Scientific Reports, 15: 22286.