Abstract
Background: Osteoporosis is the most common metabolic bone disease and can cause fragility fractures. Despite this, screening utilization rates for osteoporosis remain low among populations at risk. Automated bone mineral density (BMD) estimation using computed tomography (CT) can help bridge this gap and serve as an alternative screening method to dual-energy X-ray absorptiometry (DXA).Methods: The feasibility of an opportunistic and population agnostic screening method for osteoporosis using abdominal CT scans without bone densitometry phantom-based calibration was investigated in this retrospective study. A total of 268 abdominal CT-DXA pairs and 99 abdominal CT studies without DXA scores were obtained from an oncology specialty clinic in the Republic of Korea. The center axial CT slices from the L1, L2, L3, and L4 lumbar vertebrae were annotated with the CT slice level and spine segmentation labels for each subject. Deep learning models were trained to localize the center axial slice from the CT scan of the torso, segment the vertebral bone, and estimate BMD for the top four lumbar vertebrae.Results: Automated vertebra-level DXA measurements showed a mean absolute error (MAE) of 0.079, Pearson’s <i>r</i> of 0.852 (<i>P</i><0.001), and <i>R</i><sup>2</sup> of 0.714. Subject-level predictions on the held-out test set had a MAE of 0.066, Pearson’s <i>r</i> of 0.907 (<i>P</i><0.001), and <i>R</i><sup>2</sup> of 0.781.Conclusion: CT scans collected during routine examinations without bone densitometry calibration can be used to generate DXA BMD predictions.