Flag patients at risk of low bone density before a fracture.
For executives, service line leaders and population health teams. Many osteoporotic fractures follow a missed opportunity: an earlier X-ray that could have prompted bone health care and did not.1,2,3 Rho screens the X-rays your system takes, at every site, so the pathway can start before a fracture.
Fractures are common, deadly and expensive.
Medicare claims from 2016, analyzed by Milliman for the National Osteoporosis Foundation.
According to the SCOPE 2021 scorecard,12 across the 27 EU countries, the UK and Switzerland in 2019:
- 4.3 million
New fragility fractures in one year.
- 248,487
Deaths caused by fragility fractures in one year.
- €56.9 billion
Direct cost of fragility fractures in one year, not counting quality of life lost.
- 2.1 million
Osteoporotic fractures among Medicare beneficiaries in one year, affecting about 1.8 million people.4
- 1 in 5
Fee-for-service beneficiaries who died within 12 months of a new osteoporotic fracture, from any cause. After a hip fracture, 30%.4
- $21,600
Added medical cost to Medicare in the year after a new fracture, in 2016 claims, roughly doubling the prior year. Skilled nursing spending rose about 260%.4
A hip fracture carries a 5 to 8 times higher risk of death in the first three months.5 Only 40 to 60% of patients recover their previous mobility, and 10 to 20% are institutionalized.6
Screening that depends on someone ordering a DXA has not closed it.
Guidelines recommend assessing fracture risk in older adults and after a fragility fracture. In practice, most people at high risk are not identified or treated.
Guidelines recommend bone density testing for women 65 and older, men 70 and older, and adults 50 and older after a fracture.7,127 In practice, many eligible patients are not tested, and DXA use has been falling for two decades.
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After a fracture
Up to 80% of people who have already had a fragility fracture are neither identified nor treated for osteoporosis.13
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Among women at high risk
71% of women at high risk of fracture in the EU, the UK and Switzerland were not treated in 2019, about 14 million women.12
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The trend
The treatment gap widened from 55% in 2010 to 71% in 2019, while the number of DXA scanners grew by about 5%.12
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After a fracture
Only 9% of women and 5% of men on Medicare fee-for-service had a bone density test within six months of a new osteoporotic fracture. About 14% fractured again within a year.4
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Among women eligible for screening
26.5% of insured women aged 65 to 79, and 12.8% of women 80 and older, had a DXA over a two-year window.13
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The trend
DXA use among Medicare beneficiaries fell 35% between 2005 and 2023, from 7,255 to 4,690 tests per 100,000 beneficiaries.14
- 4 Milliman, 2021 ↗
- 7 BHOF 2022 (LeBoff et al., Osteoporosis International) ↗
- 12 USPSTF 2025 (Nicholson et al., JAMA) ↗: women 65 and older
- 13 Gillespie and Morin, Am J Med, 2017 ↗
- 14 Pelzl et al., Osteoporosis International, 2026 ↗
- 12 Kanis et al. (SCOPE 2021), Archives of Osteoporosis, 2021 ↗
- 13 Hernlund et al., Archives of Osteoporosis, 2013 ↗
Close the loop from routine X-rays.
A fracture liaison service finds patients after a fracture.7 Rho flags patients earlier, in imaging done for other reasons, so a similar pathway can assess them.
More assessments, more diagnoses, higher yield.
- 1.8×
Increase in initial DXAs after radiologists began reporting Rho findings, in a before-and-after comparison at one eight-site Ontario imaging provider (34,162 X-rays over 13 months). Rho-prompted DXAs confirmed low bone density in 87% of patients, versus 69% for usual care.8
- 36% vs 18%
Rho-positive vs Rho-negative patients who said they had discussed bone health with their primary care provider within six months, in a prospective hospital study.9
- 11% vs 5%
Rho-positive vs Rho-negative patients who said they had been newly diagnosed with osteoporosis within six months, in the same study.9
- 8 Syme et al., Skeletal Radiology, 2026 ↗: a before-and-after comparison at one eight-site Ontario imaging provider
- 9 Jayarajah et al., Canadian Association of Radiologists Journal, 2025 ↗: a prospective study at one Canadian hospital
What the published models say, and what we claim.
The savings from preventing fractures are real but belong to the whole pathway: screening, assessment and treatment. Rho is the first step. We do not claim that Rho by itself reduces fractures or costs.
What Rho does is augment the first step, using X-rays that have been taken. It runs on imaging done for other reasons, is licensed on X-ray volume, and flags more of the right patients for assessment by your bone health clinic.
Model the pathway for your system →-
Secondary fractures
Milliman modeled that preventing 5 to 20% of subsequent fractures could have saved Medicare fee-for-service $272 million to $1.1 billion for one year's fracture cohort, including the cost of added bone density tests but not treatment or program costs.4
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Programs that close the loop
Across 74 controlled studies, fracture liaison services roughly doubled bone density testing (48% vs 24%) and treatment initiation (38% vs 17%), with an absolute re-fracture reduction of about 5 percentage points.10 Kaiser Permanente Southern California attributed a 40%+ reduction in expected hip fractures in 2009 to more DXA screening followed by treatment.11
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Opportunistic screening
A 2025 US model found AI screening of existing chest radiographs cost-effective in women 50 and older at $72,085 per quality-adjusted life year, below the $100,000 threshold. The model is of the approach, not of Rho, and assumes realistic follow-up DXA and treatment rates.15
A 2025 model for Germany found AI screening of existing chest radiographs cost-effective in women 50 and older at €13,340 per quality-adjusted life year, well below a €60,000 threshold. The model is of the approach, not of Rho, and depends on follow-up DXA, treatment and adherence.14
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Rho's cost
An annual software license priced on gross X-ray volume. No new exam or technologist step, and Rho runs on a virtual machine on your existing infrastructure. Where DXA capacity is in your system, the added referrals are reimbursed within it.
One installation for the whole system.
Every site that sends to your PACS
Rho Enterprise runs on one virtual machine inside your network and receives studies by standard DICOM routing, so hospitals, outpatient centers and affiliated clinics are covered together.
Data stays inside your network
Images and patient data are not transferred to 16 Bit. Rho has undergone a cybersecurity risk assessment as part of its FDA De Novo authorization, and we work with you to complete the necessary cybersecurity and AI governance procedures your institution has.
No change to your workflow
Rho runs in the background on X-rays as they reach PACS. Technologists and radiologists keep working as they do today: a Rho Report appears in PACS for flagged studies, and the physician reading the X-ray decides whether to include the finding.
Live in about a week
Installation, IT training and configuration usually take about an hour. IT administrators are trained in a 10-minute session, and we provide a short briefing to circulate to the physicians who read the X-rays, with an optional dictation macro. Motivated sites screen within a week of a purchase decision.
In clinical and research use at imaging networks, orthopedic groups, and hospitals around the world
Model the pathway for your system.
Bring your X-ray volume, DXA capacity and fracture numbers. We will show what Rho would flag, how the loop closes, and what other systems have measured.