Can deep learning software detect a vertebral fracture on a routine CT scan?

Deep learning (DL) software can detect vertebral fractures on routine CT scans, and the evidence for this is fairly consistent. A vertebral fracture is a break or collapse in one of the bones of the spine. These fractures are common and often missed when a CT is done for another reason, such as a lung or belly scan ². Pooled results from seven studies found that DL software spotted at least one moderate or severe vertebral fracture with a sensitivity of 0.83 and a specificity of 0.92 ². Sensitivity means how often the software correctly flags a fracture that is really there. Specificity means how often it correctly stays quiet when there is no fracture.

What the research says

A 2026 review pooled seven retrospective studies published between 2020 and 2025, covering 11,615 patients ². All of them tested stand-alone DL software for finding at least one vertebra with a Genant grade 2 or 3 fracture, which means a moderate or severe collapse ². The pooled sensitivity was 0.83 (95% CI 0.73 to 0.90) and specificity was 0.92 (95% CI 0.90 to 0.94) ². The positive likelihood ratio was 10.44 and the negative likelihood ratio was 0.19, which suggests the software is good at ruling a fracture in when it flags one and fairly good at ruling it out when it does not ². Sensitivity bounced around more than specificity between studies, and the authors noted this may reflect differences in the mix of cases or in the cutoffs used ². Most of the included studies used external validation, and risk of bias was low to moderate ².

What to ask your doctor

• Ask whether your CT report already mentions bone density or spine height, since vertebral fractures are often missed on routine scans ².
• Ask if your hospital or imaging center uses any deep learning or AI software to check spine bones on CT, and what its accuracy is ²⁶.
• Ask how a software flag would be confirmed, since a radiologist still reads the images and makes the final call ⁶.
• Ask whether a fracture found on CT should also be checked with a bone density test or other imaging to guide treatment ⁴.
• Ask what steps can lower your risk of future spine fractures if one is found ¹⁵.