A Study Evaluating the Performance of Using AI Software and Chest X-rays to Screen for Osteoporosis as Compared to Standard DXA Scans in Patients 50 Years and Older

Inclusion Criteria: 1. Age ≥50 years at the time of chest X-ray 2. Availability of 1. Posteroanterior (PA) Chest X-ray and 2. DXA scan with a valid T-score measurement where both the DXA scan and Chest x-ray examinations were performed within 6 months (182 days) of each other and 3. Available X-ray and DXA scans performed on or after 01-Jan-2010. 3. Complete metadata (sex and age) available on PACS or hospital records. Exclusion Criteria: 1. Non-diagnostic Quality or Incomplete Imaging of: 1. DXA scan inadequacy: Missing T-score from a technically inadequate scan. 2. PA Chest X-ray technical inadequacy: Non-PA projection, significant motion artefacts, inadequate visualisation of thoracic structures, or missing DICOM metadata. 3. Image format incompatibility: Non-DICOM format or corrupted image files that would prevent AI analysis 4. PA Chest X-ray \> ±6 months from the date of the DXA scan. 2. Previous diagnosis or treatment of Osteoporosis prior to the DXA scan used in the Study. 1. diagnosis of osteoporosis (T-score ≤-2.5), or current/recent anti- osteoporotic medications, within 12 months prior to the DXA scan used in the study. 2. Current or recent anti-osteoporotic medications for 3 months (91 days) continuously prior to the Chest x-ray used in the Study. 3. Diagnosis of any metabolic bone disease prior to the DXA scan used in the study. 4. Diagnosis of metabolic bone disease other than Osteoporosis or Osteopenia, up to a maximum of 3 months (91 days) after the DXA scan. 5. Major Chest Wall or Spinal Deformities, including but not limited to: 1. Severe structural deformities: Thoracic scoliosis with Cobb angle \>40°, severe kyphosis, or chest wall deformities (pectus excavatum/carinatum) affecting \>30% of the thoracic cage. 2. Surgical hardware: Previous thoracic/spinal surgery with metallic implants obscuring anatomical landmarks required for AI analysis. 3. Pathological conditions: Extensive pulmonary consolidation, pleural effusion, lesions or masses obscuring \>30% of thoracic skeletal structures 6. Subject has opted out of confidential data being used for research purposes