{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:02:36Z","timestamp":1768827756855,"version":"3.49.0"},"reference-count":17,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["BRC-1215-20014"],"award-info":[{"award-number":["BRC-1215-20014"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"crossref","award":["RfPB PB_PG_0816_20027"],"award-info":[{"award-number":["RfPB PB_PG_0816_20027"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR Cambridge Biomedical Research Centre (BRC-121"],"award-info":[{"award-number":["NIHR Cambridge Biomedical Research Centre (BRC-121"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,4,14]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Two million out of the UK\u2019s 5 million routine diagnostic CT scans performed each year incorporate the thoracolumbar spine or pelvic region. Up to one-third reveal undiagnosed osteoporosis or vertebral fractures. We developed an intervention, Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays (\u2018PHOENIX\u2019), to facilitate early detection and management of osteoporosis in people attending hospitals for CT scans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A multicentre, randomised, pragmatic feasibility study. From the general CT-attending population, women aged \u226565\u2009years and men aged \u226575 years attending for CT scans are invited to participate, via a novel consent form incorporating Fracture Risk Assessment (FRAX) questions. Those at increased 10-year risk (within the amber or red zones of the UK FRAX graphical outputs for further action) are block randomised (1:1:1) to (1) PHOENIX intervention, (2) active control or (3) usual care. The PHOENIX intervention comprises (i) retrieving the CT scans using the NHS Image Exchange Portal, (ii) Mindways QCT Pro software analysis of CT hip and spine none density with CT vertebral fracture assessment, (iii) sending the participants\u2019 general practitioner (GP) a clinical report including diagnosis, necessary investigations and recommended treatment. Baseline CT scans from groups 2 and 3 are assessed with the PHOENIX intervention only at study end. Assuming 25% attrition, the study is powered to find a predicted superior osteoporosis treatment rate with PHOENIX (20%) vs 16% among patients whose GPs were sent the FRAX questionnaire only (active control) and 5% in the usual care group. Five hospitals are participating to determine feasibility. The co-primary feasibility outcome measures are (a) ability to randomise 375 patients within 10 months and (b) retention of 75% of survivors, completing their 1-year bone health outcome questionnaire. Secondary 1-year outcomes include osteoporosis\/vertebral fracture identification rates and osteoporosis treatment rates. Stakeholder acceptability and economic aspects are evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approved by committee (National Research Ethics Service) East of England (EE) as REF\/19\/EE\/0176. Dissemination will be through the Royal Osteoporosis Society (to patients and public) as well as to clinician peers via national and international bone\/rheumatology scientific and clinical meetings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN14722819\">ISRCTN14722819<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050343","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T04:02:11Z","timestamp":1653451331000},"page":"e050343","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["PHOENIX (Picking up Hidden Osteoporosis Effectively during Normal CT Imaging without additional X-rays): protocol for a randomised, multicentre feasibility study"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"isrctn14722819","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4546-7352","authenticated-orcid":false,"given":"Kenneth E S","family":"Poole","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Cambridge, Cambridge, UK"},{"name":"NIHR Cambridge Biomedical Research Centre, Cambridge, UK"},{"name":"Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1958-6246","authenticated-orcid":false,"given":"Daniel D G","family":"Chappell","sequence":"additional","affiliation":[{"name":"NIHR Cambridge Biomedical Research Centre, Cambridge, UK"},{"name":"Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Clark","sequence":"additional","affiliation":[{"name":"Clinical Science at North Bristol, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8127-2061","authenticated-orcid":false,"given":"Jane","family":"Fleming","sequence":"additional","affiliation":[{"name":"Cambridge Public Health, University of Cambridge, Cambridge, UK"},{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee","family":"Shepstone","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D","family":"Turmezei","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge, Cambridge, UK"},{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"},{"name":"Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9101-3477","authenticated-orcid":false,"given":"Adam P","family":"Wagner","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"},{"name":"NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2039-1155","authenticated-orcid":false,"given":"Karen","family":"Willoughby","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge, Cambridge, UK"},{"name":"NIHR Cambridge Biomedical Research Centre, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen K","family":"Kaptoge","sequence":"additional","affiliation":[{"name":"Cambridge Public Health, University of Cambridge, Cambridge, UK"},{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,24]]},"reference":[{"key":"2025121605512442000_12.5.e050343.1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00198-015-3318-4","article-title":"Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density","volume":"27","author":"Lee","year":"2016","journal-title":"Osteoporos 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