Development of Artificial Intelligence-Assisted Lumbar and Femoral BMD Estimation System Using Anteroposterior Lumbar X-Ray Images.

Journal: Journal of orthopaedic research : official publication of the Orthopaedic Research Society
Published Date: Jul 9, 2025

Abstract

The early detection and treatment of osteoporosis and prevention of fragility fractures are urgent societal issues. We developed an artificial intelligence-assisted diagnostic system that estimated not only lumbar bone mineral density but also femoral bone mineral density from anteroposterior lumbar X-ray images. We evaluated the performance of lumbar and femoral bone mineral density estimations and the osteoporosis classification accuracy of an artificial intelligence-assisted diagnostic system using lumbar X-ray images from a population-based cohort. The artificial neural network consisted of a deep neural network for estimating lumbar and femoral bone mineral density values and classifying lumbar X-ray images into osteoporosis categories. The deep neural network was built by training dual-energy X-ray absorptiometry-derived lumbar and femoral bone mineral density values as the ground truth of the training data and preprocessed X-ray images. Five-fold cross-validation was performed to evaluate the accuracy of the estimated BMD. A total of 1454 X-ray images from 1454 participants were analyzed using the artificial neural network. For the bone mineral density estimation performance, the mean absolute errors were 0.076 g/cm for the lumbar and 0.071 g/cm for the femur between dual-energy X-ray absorptiometry-derived and artificial intelligence-estimated bone mineral density values. The classification performances for the lumbar and femur of patients with osteopenia, in terms of sensitivity, were 86.4% and 80.4%, respectively, and the respective specificities were 84.1% and 76.3%. CLINICAL SIGNIFICANCE: The system was able to estimate the bone mineral density and classify the osteoporosis category of not only patients in clinics or hospitals but also of general inhabitants.

Authors

  • Toru Moro
    Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Noriko Yoshimura
    Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, 113-8655, Japan.
  • Taku Saito
    Sensory and Motor System Medicine, Faculty of Medicine Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Hiroyuki Oka
    Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
  • Sigeyuki Muraki
    Sensory and Motor System Medicine, Faculty of Medicine Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Toshiko Iidaka
    Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
  • Takeyuki Tanaka
    Sensory and Motor System Medicine, Faculty of Medicine Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Kumiko Ono
    Sensory and Motor System Medicine, Faculty of Medicine Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Hisatoshi Ishikura
    Sensory and Motor System Medicine, Faculty of Medicine Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Naoya Wada
    Advanced Technology Research Institute, Corporate R&D Group, KYOCERA Corporation, Kawasaki, Kanagawa, Japan.
  • Kenichi Watanabe
    Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Masayuki Kyomoto
    Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Sakae Tanaka
    Department of Orthopedic Surgery, Sensory and Motor System Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

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