Available online 26 October 2025, 101638

Osteoporosis is a prevalent and growing public health issue, particularly in aging populations, due to its association with fragility fractures, reduced mobility, and increased healthcare burden. Dual-energy X-ray absorptiometry (DXA) remains the clinical gold standard for assessing bone mineral density (BMD), but it requires dedicated equipment. DXA is separately required from the radiography system for fracture diagnosis, making DXA difficult to access depending on the facility and region.

To address these limitations, we developed the quantitative bone (Q-BONE) system, a novel diagnostic tool that updates existing radiography system to utilize dual energy in a single X-ray irradiation to produce BMD (Q-BONE score) and high-resolution X-ray images (Q-BONE images).

We evaluated the correlation between the Q-BONE score of Q-BONE system and the BMD of the DXA for the DXA measurement phantom and the 200 people, and the degree of agreement among them by Bland-Altman analysis. Further, fracture detectability was compared between Q-BONE images and radiographs using predefined radiological criteria.

The correlation between bone mineral density and Q-BONE score for 200 individuals was as high as 0.91 with good linearity; however, these two values were statistically inconsistent mainly because of body fat percentage (P < 0.05). Q-BONE images significantly improved visualization of cortical and trabecular bone structures (P < 0.01) and improved detection of fractures and structural abnormalities compared with conventional radiographs.

The Q-BONE system has the potential that achieves comprehensive osteoporosis assessment by combining BMD measurement and fracture evaluation in a single efficient procedure. Its implementation could improve diagnostic efficiency and accessibility, particularly in settings where DXA is unavailable. Further technical improvement on body fat issues, and studies are warranted to assess its clinical utility across broader populations and skeletal sites.

osteoporosis

bone mineral density

fracture detection

Dual-energy

Q-BONE

© 2025 The Authors. Published by Elsevier Inc. on behalf of The International Society for Clinical Densitometry.