Four artificial intelligence (AI) technologies that could help
healthcare professionals spot spinal fractures in patients
undergoing routine CT scans have today (Tuesday 15 July 2025)
been conditionally recommended by NICE.
The technologies can help detect vertebral fragility fractures
(VFFs) on medical images taken for unrelated conditions,
potentially identifying fractures in thousands of patients who
would otherwise go undiagnosed.
By spotting these fractures opportunistically, they can be
treated and future fractures avoided, which could save the NHS
money and result in better outcomes for patients.
Vertebral fragility fractures (VFFs) are breaks in the spine that
occur when bones are weakened, often by osteoporosis. Fractures
of the spine may not always have obvious symptoms and even if
symptomatic, a person may choose not to seek care. Undiagnosed
VFFs lead to complications such as a curved spine (causing the
person to lean forward), height loss, immobility, pain, as well
as loss of function. VFFs are also a significant predictor of
future osteoporotic fractures[i] such as hip fractures.
More than 55% of people with a hip fracture have evidence of
previous VFFs[1]. Despite their prevalence, many VFFs remain
undiagnosed.
NICE's independent Diagnostics Advisory Committee has
conditionally recommended that BriefCase-Triage, CINA-VCF
Quantix, HealthVCF and IB Lab FLAMINGO can be used in the NHS
while further evidence is generated.
The draft guidance emphasises that AI technologies must only be
used alongside clinical judgement, not as replacements for
radiologist review.
Dr Anastasia Chalkidou, HealthTech programme director at
NICE, said: “Despite ongoing efforts to raise awareness
of vertebral fragility fractures, most remain undiagnosed.
“Clinical evidence suggests that AI technologies can help
opportunistically detect vertebral fragility fractures that would
otherwise have been missed.
“By identifying more people with VFFs who need treatment for the
underlying cause of the fracture, we could reduce the risk of
future fractures, while potentially reducing demand on other
costly services such as those needed to manage hip fractures.”
The incidence of VFFs increases with age. Recent data shows an
incidence rate of 7.1 per 10 000 person years in adults aged over
50[1][1]. Women are more commonly affected. An incidence of 12%
has been reported in women aged 50 to 79 years, increasing to 20%
in women over 80 years old.
The costs associated with VFFs and hip fractures are significant
– the health and social care costs in the first year of post-hip
fracture are over £33,000 per person[1][1][1].
The committee concluded that there is a clear unmet clinical need
that can be addressed by the AI technologies, noting that
thousands of radiographic images are taken annually in the NHS
that could be used to opportunistically detect VFFs.
Professor Neil Hawkins, vice-chairman of NICE's
Diagnostics Advisory Committee said:“There is clearly
great interest in this technology. However, we need further
evidence from ‘real-world' clinical settings to establish whether
investing in AI to aid opportunistic detection represents good
value for money.
“The four technologies have been conditionally recommended for
NHS use over the next three years while further evidence is
generated. Once this period has been completed, the committee
will review the evidence and make recommendations on which
technologies should be used going forward.”
During the three-year evidence generation period, research will
focus on several key areas including diagnostic accuracy compared
with current NHS standard care, failure rates of the
technologies, impact on referral and treatment rates, effects on
healthcare professional workload, and short-term quality of life
improvements.
A consultation on the draft recommendations has now begun.
Healthcare professionals, commissioners, and patients are
encouraged to review the full recommendations to understand how
the four technologies can be used by the NHS and submit comments
before Tuesday 29 July 2025.
ENDS
References
[1] Royal College of Radiologists,
2021
[1][1] Curtis et al. 2016
[1][1][1] Royal College of Radiologists,
2021
About the guidance
- The draft guidance will be available at https://www.nice.org.uk/guidance/indevelopment/gid-hte10059/consultation/html-content-2
