Survey of AI-Powered Approaches for Osteoporosis Diagnosis in Medical Imaging

Abstract: Osteoporosis silently erodes skeletal integrity worldwide; however, early detection through imaging can prevent most fragility fractures. AI methods now mine routine Dual-energy X-ray Absorptiometry (DXA), X-ray, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) scans for subtle, clinically actionable markers, but the literature is fragmented. This survey unifies the field through a tri-axial framework that couples imaging modalities with clinical tasks and AI methodologies (classical machine learning, convolutional neural networks (CNNs), transformers, self-supervised learning, and explainable AI). Following a concise clinical and technical primer, we detail our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided search strategy, introduce the taxonomy via a roadmap figure, and synthesize cross-study insights on data scarcity, external validation, and interpretability. By identifying emerging trends, open challenges, and actionable research directions, this review provides AI scientists, medical imaging researchers, and musculoskeletal clinicians with a clear compass to accelerate rigorous, patient-centered innovation in osteoporosis care. The project page of this survey can also be found on Github.