Opportunistic osteoporosis screening in heavy smokers
Principal Investigator
Name
Maximilian Löffler
Degrees
M.D. Dipl.-Ing.
Institution
University Medical Center Freiburg
Position Title
Senior Researcher (postdoctoral habilitation)
About this CDAS Project
Study
NLST
(Learn more about this study)
Project ID
NLST-1482
Initial CDAS Request Approval
Dec 22, 2025
Title
Opportunistic osteoporosis screening in heavy smokers
Summary
The U.S. Preventive Services Task Force (USPSTF) currently recommends dual-energy x-ray absorptiometry (DXA) for osteoporosis screening in women aged 65 years and older, and in younger postmenopausal women with additional risk factors. DXA is the established standard for measuring BMD due to its low radiation dose and correlation with fracture risk. Quantitative computed tomography (QCT) offers three-dimensional BMD assessment with higher diagnostic accuracy but is less available and more costly. These constraints may be overcome through opportunistic BMD assessment—using routinely acquired clinical CT scans for secondary purposes.
This project investigates whether opportunistic BMD measurements from LDCT scans can identify individuals at increased risk of vertebral fractures and all-cause mortality among heavy smokers enrolled in the National Lung Screening Trial (NLST).
Aims
Central Hypothesis:
Opportunistic BMD assessment from LDCT can reliably predict vertebral fractures and mortality independent of traditional clinical risk factors, enabling improved risk stratification in heavy smokers.
Aim 1:
Evaluate the association between LDCT-derived BMD and incident vertebral fractures.
Rationale: Osteoporotic fractures are underdiagnosed in smokers due to limited DXA screening.
Approach: Using automated software, baseline LDCT scans from NLST participants will be analyzed for vertebral BMD and fractures. Incident fractures after 1–2 years will be identified and correlated with baseline BMD.
Aim 2:
Determine whether LDCT-derived BMD predicts all-cause mortality.
Rationale: Osteoporosis reflects systemic frailty, potentially influencing survival beyond fracture risk.
Approach: Multivariable regression models will assess the association between BMD and 6-year mortality, adjusting for age, sex, smoking status, comorbidities, and baseline vertebral fractures.
Aim 3:
Assess the potential clinical utility of integrating opportunistic BMD screening into lung cancer screening programs.
Rationale: Combining fracture risk and mortality prediction could enhance preventive care for smokers.
Approach: Model cost-effectiveness, workflow integration, and potential intervention impact (e.g., pharmacologic therapy for osteoporosis).
Collaborators
Maximilian Löffler University Medical Center Freiburg
Jakob Weiß University Medical Center Freiburg