Project MHSC02

PHOENIX-Feasibility: Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays

The PHOENIX aimed to facilitate early detection and management of osteoporosis. The PHOENIX pathway uses CT images(from people already attending CT scans)to identify osteoporosis enabling early treatment and potentially preventing future fractures. The new technology makes it simple to measure bone density quickly and identify vertebral fractures from CT images of a patient's torso or pelvis.

Background

Osteoporosis makes bones become porous and break more easily. In the UK, osteoporosis causes 200,000 vertebral fractures yearly. Patients are often left undiagnosed. A computerised tomography (CT) scan uses x-rays and a computer to create images of the body; two million are performed each year. Nearly a third have osteoporosis or vertebral fractures without knowing it. The PHOENIX pathway uses new technology to measure bone density from CT images of a patient's torso or pelvis, identifying vertebral fractures and osteoporosis. Measurements of the spine and hips are performed on images acquired from any CT scanner. Patients already attending hospital for a CT scan will be invited to participate. One group will be allocated to the PHOENIX pathway. The other group will follow usual care where their osteoporosis risk questionnaire is sent to their general practitioner. The feasibility study will help plan a future trial.

Project Aims

  • The feasibility study helped plan a future trial.
  • It tested willingness to volunteer and consent to follow-up.
  • It assessed Addenbrookes Hospitals' capability to connect to hospitals in a hub and spoke model to provide the service.

Project Activity

  • The Phoenix-f trial protocol has been published. The feasibility study has finished recruitment and the results are being analysed.
  • An extension study was carried out to determine whether the patient's treatment report should be sent to the GP or whether treatment should be continued within the hospital. The results of this extension component are being analysed.

Outputs 

  • The feasibility informed a future trial to determine if the PHOENIX pathway will lead to better osteoporosis treatment rates and fewer painful fractures.
  • Invited by the NIHR to apply for definitive trial funding through the RfPB fast track method and have submitted Stage 2 application in summer 2025 round. 
  • Paper finalised on the PHOENIX study which is also completed and in an online repository https://www.medrxiv.org/content/10.1101/2025.07.17.25331283v1, sent the paper for peer review using the Medrxiv portal.
  • The use of QCT in daily clinical practice with Dan Chappell in particular leading efforts for more widespread adoption through his spin out activities. 

Papers/resources 

Read the paper titled, 'PHOENIX (Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays): protocol for a randomised, multicentre feasibility study'

Read the final report titled, 'PHOENIX-Feasibility: Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays (Short Title: PHOENIX-F)'

Who was involved? 

  • Kenneth Poole (PI), Department of Medicine, University of Cambridge, Cambridge, UK. NIHR Cambridge Biomedical Research Centre, Cambridge, UK. Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Adam Wagner (corresponding researcher), Norwich Medical School, University of East Anglia, Norwich, UK. NIHR Applied Research Collaboration (ARC) East of England.
  • Dan Chappell, Department of Medicine, University of Cambridge, Cambridge, UK. Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Prof Emma Clark, Clinical Science at North Bristol, University of Bristol, Bristol, UK.
  • Jane Flemming, Cambridge Public Health, University of Cambridge, Cambridge, UK. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Stephen Kaptoge, Cambridge Public Health, University of Cambridge, Cambridge, UK. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Helen Risebro, Norwich Medical School, University of East Anglia, Norwich, UK. NIHR Applied Research Collaboration (ARC) East of England.
  • Lee Shepstone, Norwich Medical School, University of East Anglia.
  • Thomas D Turmezei, Department of Medicine, University of Cambridge, Cambridge, UK. Norwich Medical School, University of East Anglia, Norwich, UK. NIHR Applied Research Collaboration (ARC) East of England.
  • Karen Willoughby, Department of Medicine, University of Cambridge, Cambridge, UK. NIHR Cambridge Biomedical Research Centre, Cambridge, UK.

Contact

kesp2@cam.ac.uk
 

MHSC02