Simultaneous automated ascertainment of prevalent vertebral fracture and abdominal aortic calcification in clinical practice: Role in fracture risk assessment

Abstract

Whether simultaneous automated ascertainments of prevalent vertebral fracture (auto-PVFx) and abdominal aortic calcification (auto-AAC) on vertebral fracture assessment (VFA) lateral spine bone density (BMD) images jointly predict incident fractures in routine clinical practice is unclear. We estimated the independent associations of auto-PVFx and auto-AAC primarily with incident major osteoporotic and secondarily with incident hip and any clinical fractures in 11 013 individuals (mean [SD] age 75.8 [6.8] years, 93.3% female) who had a BMD test combined with VFA between March 2010 and December 2017. Auto-PVFx and auto-AAC were ascertained using convolutional neural networks (CNNs). Proportional hazards models were used to estimate the associations of auto-PVFx and auto-AAC with incident fractures over a mean (SD) follow-up of 3.7 (2.2) years, adjusted for each other and other risk factors. At baseline, 17% (n = 1881) had auto-PVFx and 27% (n = 2974) had a high level of auto-AAC (≥ 6 on scale of 0 to 24). Multivariable-adjusted hazard ratios (HR) for incident major osteoporotic fracture (95% CI) were 1.85 (1.59, 2.15) for those with compared with those without auto-PVFx, and 1.36 (1.14, 1.62) for those with high compared with low auto-AAC. The multivariable-adjusted HRs for incident hip fracture were 1.62 (95% CI, 1.26 to 2.07) for those with compared to those without auto-PVFx, and 1.55 (95% CI, 1.15 to 2.09) for those high auto-AAC compared with low auto-AAC. The 5-year cumulative incidence of major osteoporotic fracture was 7.1% in those with no auto-PVFx and low auto-AAC, 10.1% in those with no auto-PVFx and high auto-AAC, 13.4% in those with auto-PVFx and low auto-AAC, and 18.0% in those with auto-PVFx and high auto-AAC. While physician manual review of images in clinical practice will still be needed to confirm image quality and provide clinical context for interpretation, simultaneous automated ascertainment of auto-PVFx and auto-AAC can aid fracture risk assessment.

Document Type

Journal Article

Date of Publication

7-1-2024

Volume

39

Issue

7

Funding Information

Rady Innovation Fund / Royal Perth Hospital Medical Research Foundation (2-30\u2009699) / National Heart Foundation of Australia (102817) / Raine Medical Research Foundation

PubMed ID

38699950

School

Nutrition and Health Innovation Research Institute / Centre for Artificial Intelligence and Machine Learning / School of Science

Copyright

subscription content

Publisher

Oxford Academic

Comments

Schousboe, J. T., Lewis, J. R., Monchka, B. A., Reid, S. B., Davidson, M. J., Kimelman, D., ... & Leslie, W. D. (2024). Simultaneous automated ascertainment of prevalent vertebral fracture and abdominal aortic calcification in clinical practice: role in fracture risk assessment. Journal of Bone and Mineral Research, 39(7), 898-905. https://doi.org/10.1093/jbmr/zjae066

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Link to publisher version (DOI)

10.1093/jbmr/zjae066