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0.9% against 5.9%: the scan you already had may be saying something about your bones

Qurexa Editorial Team28 October 20267 min read 0 0
0.9% against 5.9%: the scan you already had may be saying something about your bones

What happened

On Tuesday 27 October 2026, the journal Radiology published a study showing that lung cancer screening scans can also reveal who is at high risk of breaking a bone in their spine. The work was led by Dr Maximilian Löffler at University Medical Center Freiburg in Germany. The team went back to scans from the United States National Lung Screening Trial. That trial offered low-dose CT scans to people at high risk of lung cancer: heavy smokers aged 55 to 74 with a history of at least 30 pack-years. A pack-year means smoking 20 cigarettes a day for a year, so 30 pack-years is a lot of smoking. The researchers analysed the baseline scans of 21,856 people. They used software to automatically measure the density of the bones in the chest and lower back. Nobody needed an extra scan, an extra appointment or an extra dose of radiation. The information was already sitting in pictures taken for a completely different reason. They then looked at what happened to those people over the following years.

Why this matters

Osteoporosis is a condition where bones become weaker and break more easily. It is common, it is treatable, and it is badly under-diagnosed. Very often the first anyone knows about it is a fracture. Spinal fractures are particularly easy to miss. They do not always come from a fall. A bone in the spine can simply collapse a little under everyday load. People put the back pain down to age. Height is lost quietly. The posture changes. And once you have had one, the risk of another goes up. So the appeal of this study is obvious. A large number of people are already having low-dose CT scans for lung cancer screening. In England, the NHS Lung Cancer Screening Programme is being rolled out and invites people aged 55 to 74 who smoke or used to smoke. Every one of those scans contains bone, whether anybody looks at it or not. There is also a reason to expect bone trouble in this particular group. Smoking itself weakens bone. So does the chronic lung disease that often comes with it, and the steroid treatment that sometimes goes with that. The people being scanned for lung cancer are, as a group, people whose bones deserve a look.

What the evidence actually says

The researchers sorted people into three groups by bone density: normal, low bone mass, and osteoporotic. Among the 18,211 people who had a follow-up scan two years later, the pattern was clear. In the normal bone density group, 0.9% had a new spinal fracture within two years. In the low bone mass group, it was 2.0%. After adjusting for other factors, that was just over twice the risk of the normal group. In the osteoporotic group, it was 5.9%. That was around 3.4 times the risk of the normal group. The authors make a pointed observation about that 5.9% figure. It is above the level at which current guidelines recommend starting medication to protect bone. In other words, these were people who, had anyone known, would have qualified for treatment. There was a second finding. Osteoporotic bone density was linked with dying from any cause over six years in men, but not in women once everything else was accounted for. The limits matter. This was a look back at existing data, not a trial. It shows that measuring bone on these scans identifies people at higher risk. It does not yet show that doing so leads to fewer fractures, because nobody has tried it and measured the result. Dr Miriam Bredella of NYU Langone Health, writing an editorial alongside the study, made that exact point. She argued the challenge now is putting it into practice rather than proving it can be measured, and called for a trial to test whether automatic risk-flagging and clear care pathways actually get the right people treated, without over-treating everybody else.

Qurexa perspective

Bone medicines are a good example of treatments that only work if they are actually taken, and they are among the easiest to drift away from. The reason is that osteoporosis does not hurt. A tablet for pain gives you feedback. A weekly bisphosphonate gives you nothing you can feel, for years, while quietly doing its job. Some of them also have fiddly instructions: take it first thing, with a full glass of plain water, stay upright and do not eat for half an hour. Across the medicines we deliver, those are precisely the conditions under which doses get missed. Not through carelessness, but because nothing reminds you and nothing goes wrong when you forget. That is where our adherence support and regular delivery schedules earn their keep. A medicine that arrives before you run out, on a rhythm you can rely on, is a medicine you are more likely to still be taking in three years. For bone, three years is roughly where the benefit lives.

Practical advice

If you are invited to NHS lung health checks or lung cancer screening, go. The main purpose is finding lung cancer early, which is reason enough. If you have risk factors for weak bones, raise it with your GP rather than waiting for a scan to do it for you. Risk factors include being over 50, smoking now or in the past, a parent who broke a hip, long-term steroid tablets, early menopause, low body weight, heavy drinking, and some long-term conditions. If you have already had a fracture from a minor fall or from no obvious cause, that is a flag. Ask about a bone density scan, often called a DEXA scan. If you have lost height, developed a stooped upper back, or have persistent unexplained back pain, mention it. These can be signs of spinal fractures that were never diagnosed. If you are on bone protection medicine, take it exactly as instructed and keep taking it. Do not stop because you feel fine. Feeling fine is the point. Support the basics: enough calcium and vitamin D, weight-bearing exercise such as walking, and strength work if you are able. Many adults in the UK are advised to consider a daily vitamin D supplement in autumn and winter. Stopping smoking helps your bones as well as your lungs. Your pharmacy can point you to local stop smoking services.

What to know

A study of 21,856 heavy smokers published in Radiology on 27 October 2026 found that bone density measured automatically on lung cancer screening scans predicted who would fracture a bone in their spine. Two-year spinal fracture rates were 0.9% with normal bone density, 2.0% with low bone mass, and 5.9% with osteoporotic density. That last figure is above the threshold at which guidelines recommend treatment. The scans were already being taken. No extra radiation or appointment was involved. The study shows the risk can be identified. It has not yet shown that acting on it prevents fractures, and an accompanying editorial called for a practical trial to find out. If you are at risk of osteoporosis, the useful steps are available now: talk to your GP, attend screening invitations, and if you are prescribed bone medicine, keep taking it. Sources: AuntMinnie, 'LDCT predicts vertebral fracture risk in heavy smokers', 27 October 2026, https://www.auntminnie.com/clinical-news/ct/article/15975620/ldct-predicts-vertebral-fracture-risk-in-heavy-smokers ; Radiology (Radiological Society of North America), study by Löffler M et al., published 27 October 2026, https://pubs.rsna.org/journal/radiology ; NHS, 'Osteoporosis', https://www.nhs.uk/conditions/osteoporosis/ This article is for general information and does not replace advice from a doctor, pharmacist or other qualified healthcare professional. Do not start or stop any medicine on the basis of a news article.

#osteoporosis#bone health#lung screening#CT scans#smoking#research

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