Clinical justification for osteoporosis investigation: transitioning from opportunistic to diagnostic referrals from alternative forms of imaging.

Clinical justification remains fundamental to the safe use of imaging involving ionising radiation, requiring a favourable balance between diagnostic benefit and stochastic risk. Concurrently, advances in imaging technology and artificial intelligence have enabled opportunistic identification of additional pathologies beyond the primary indication for imaging. This opinion article discusses how emerging opportunistic osteoporosis detection technologies may eventually transition into clinically justified diagnostic pathways in their own right.