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Objective <p>To develop and validate an artificial intelligence-based tool for the diagnosis of osteoporosis/osteopenia using hip radiographs. The tool aims to classify femurs into risk-based categories for osteoporosis/osteopenia, enabling patient prioritization, enhancing preventive medicine through incidental detection, and assisting clinicians’ diagnosis in general.</p> Materials and methods <p>The AI tool was designed to perform three preprocessing tasks before the osteoporosis/osteopenia prediction: (1) splitting images into single femurs, (2) identifying and discarding femurs with prostheses, and (3) cropping images to isolate the proximal femur. A total of 2691 anteroposterior hip radiographs from 1654 patients were included in the study. The osteoporosis/osteopenia prediction model was trained on 3227 single femur images and tested on 826. Additionally, a final evaluation experiment was conducted on 313 new radiographs from 239 patients to assess the tool’s applicability.</p> Results <p>The tool demonstrated high performance in the preprocessing tasks, achieving 99.0% accuracy in classifying single vs. double femur images, 99.3% accuracy in identifying prosthetic femurs, and 99.2% pixel accuracy in delineating the proximal femur before cropping. The final prediction model achieved an area under the curve of 86.6% for detecting osteoporosis/osteopenia in the test set and 81.0% in the final evaluation experiment.</p> Conclusions <p>The obtained results demonstrate the potential of the proposed AI-based pipeline for prediction of osteoporosis/osteopenia using hip radiographs. This study suggests that a tool based on the proposed methods could support DXA triage, incidental osteoporosis detection, and clinical decision-making in settings with limited access to bone densitometry.</p>

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An AI-based pipeline for osteoporosis/osteopenia prediction using hip radiographs

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月26日

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  • José Acosta-Batlle,
  • David Coronado-Gutiérrez,
  • Javier Soto,
  • Jaime Moujir,
  • Carlos López,
  • Carlos Suevos Ballesteros,
  • Mónica Vázquez Díaz,
  • María del Prado Orduña Díez,
  • David Fernández,
  • Javier Blázquez Sánchez

摘要

Objective

To develop and validate an artificial intelligence-based tool for the diagnosis of osteoporosis/osteopenia using hip radiographs. The tool aims to classify femurs into risk-based categories for osteoporosis/osteopenia, enabling patient prioritization, enhancing preventive medicine through incidental detection, and assisting clinicians’ diagnosis in general.

Materials and methods

The AI tool was designed to perform three preprocessing tasks before the osteoporosis/osteopenia prediction: (1) splitting images into single femurs, (2) identifying and discarding femurs with prostheses, and (3) cropping images to isolate the proximal femur. A total of 2691 anteroposterior hip radiographs from 1654 patients were included in the study. The osteoporosis/osteopenia prediction model was trained on 3227 single femur images and tested on 826. Additionally, a final evaluation experiment was conducted on 313 new radiographs from 239 patients to assess the tool’s applicability.

Results

The tool demonstrated high performance in the preprocessing tasks, achieving 99.0% accuracy in classifying single vs. double femur images, 99.3% accuracy in identifying prosthetic femurs, and 99.2% pixel accuracy in delineating the proximal femur before cropping. The final prediction model achieved an area under the curve of 86.6% for detecting osteoporosis/osteopenia in the test set and 81.0% in the final evaluation experiment.

Conclusions

The obtained results demonstrate the potential of the proposed AI-based pipeline for prediction of osteoporosis/osteopenia using hip radiographs. This study suggests that a tool based on the proposed methods could support DXA triage, incidental osteoporosis detection, and clinical decision-making in settings with limited access to bone densitometry.