PHOENIX: Pragmatic Randomised Multi-site Study of CliniQCT 1-stop Opportunistic Bone Health Screening

Why is the research needed?

Patients referred for diagnostic Computed Tomography (CT) scans often have osteoporosis and vertebral fractures, but most remain unaware. With CliniQCT software we retrieve and reuse the patients' ordinary CT scan images to measure bone density, diagnose hidden osteoporosis and identify vertebral fractures.

What are we doing?

Our fully powered trial will extend coverage to hospitals where high osteoporosis burden coincides with unmet care needs. We will assess whether CliniQCT improves 12-month treatment rates compared with FRAX alone (a questionnaire used to detect osteoporosis), and whether it is cost-effective.

How are we working with communities, services and organisations?

We have two PPI contributors who bring prior experience and links to local Royal Osteoporosis Society groups. They will observe research processes and contribute to Trial Steering Committee meetings. To promote inclusivity, we plan to recruit wider PPI members through community groups, local osteoporosis support groups and ARC community networks.

Building on feasibility findings, the wider PPI group will co-develop patient-friendly CliniQCT and diagnosis communications through workshops. JD and JM will support patient-inclusive dissemination at conferences. We will follow the UK Standards for Public Involvement and evaluate and report PPI using PIRIT and GRIPP2.

What will the impact and benefits of this research be?

PHOENIX aims to improve osteoporosis detection in patients undergoing routine CT imaging and establish the effectiveness, cost-effectiveness and acceptability of CliniQCT and FRAX pathways. Earlier treatment could reduce subsequent fractures, pain and immobility, while improving independence and quality of life and reducing hospitalisation and long-term care. If clinically and economically worthwhile, CliniQCT could be scaled through hub-and-spoke models to areas with high fracture burden and limited provision, supporting wider NHS adoption and more equitable access to osteoporosis detection and care.

What do we have planned for knowledge mobilisation and implementation?

Our implementation strategy will build on our established partnership with the ARC EoE and Health Innovation East (HIE), drawing on their implementation and knowledge mobilisation expertise. We have begun stakeholder mapping and engagement with HIE, and will hold workshops in Years 1 and 2, particularly with primary care providers, to identify barriers and facilitators to implementation. Learning from the feasibility study will inform these plans, including the successful use of self-completed FRAX and self-consent, and findings that only 18/50 high-fracture-risk patients recommended treatment were receiving it at 12 months.

Stakeholder workshops, economic evaluation and PPI will explore the impact on primary care, while qualitative research will identify barriers and facilitators for patients, relatives, hospital services and primary care. Together, these activities will inform strategies to minimise primary care burden and support wider adoption of the intervention.

Related papers, outputs and resources 

We will engage key stakeholders through a launch event, open-access protocol, project website and PPI-developed videos, leaflets and infographics. Progress and findings will be shared through newsletters, social media and accessible participant materials, with local media engagement where appropriate. Findings will be shared through peer-reviewed publications, conferences, clinical and community networks, a dissemination workshop and a lay policy brief.