Application of Machine Learning on Health Examination Data for Predicting the Decrease of Bone Mineral Densit
Keywords:
machine learning, KNN, RF, SVM, ANN, LR, osteoporosis, osteopenia, bone mineral densityAbstract
Background: Early detection and preventive measures for reduced bone density can greatly improve patients' quality of life and reduce economic burdens. This study aimed to develop machine learning algorithms that can accurately predict the risk of bone mineral density loss. Methods: The study included participants aged 40 years and older who underwent health evaluations at an affiliated institution from January 2022 to January 2024. Five machine learning algorithms were used to predict the risk of osteoporosis: k-nearest neighbor (KNN), random forest (RF), support vector machine (SVM), artificial neural network (ANN), and logistic regression (LR). The performances were evaluated based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Results: This study included 11132 patients, of whom 3568 had decreased bone density. The initial dataset contains 17 variables. After the data screening, 13 variables were included in the machine learning model. The AUROC for ANN, KNN, LR, RF, and SVM were 0.882, 0.906, 0.684, 0.918, and 0.896 for males, and 0.881, 0.843, 0.784, 0.922, and 0.872 for females, respectively. The accuracies of ANN, KNN, LR, RF, and SVM were 0.83, 0.86, 0.75, 0.88, 0.82 for males, and 0.81, 0.77, 0.74, 0.85, 0.79 for females. Conclusion: In this study, we developed five machine learning models to predict bone density reduction accurately. The RF model performed best in both male and female populations, with the highest AUROC. Application of machine learning models in clinical settings can help improve the prevention, detection, and early treatment of bone density reduction.References
Li H, Xiao Z, Quarles LD, Li W. Osteoporosis: mechanism, molecular target, and current status on drug development. Curr Med Chem. 2021;28(8):1489-507.
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-7.
Pan B, Cai J, Zhao P, et al. Relationship between prevalence and risk of osteoporosis or osteoporotic fracture with non-alcoholic fatty liver disease: A systematic review and meta-analysis. Osteoporos Int. 2022;33(11):2275-86.
Wang Y, Tao Y, Hyman ME, Li J, Chen Y. Osteoporosis in China. Osteoporos Int. 2009;20(10):1651-62.
Zeng Q, Li N, Wang Q, et al. The prevalence of osteoporosis in china, a nationwide, multicenter DXA survey. J Bone Miner Res. 2019;34(10):1789-97.
Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int. 2015;26(7):1929-37.
Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality, and disability associated with hip fracture. Osteoporos Int. 2004;15(11):897-902.
Perrier-Cornet J, Omorou AY, Fauny M, Loeuille D, Chary-Valckenaere I. Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporos Int. 2019;30(6):1215-22.
Kwon D, Kim J, Lee H, et al. Quantitative computed tomographic evaluation of bone mineral density in beagle dogs: comparison with dual-energy x-ray absorptiometry as a gold standard. J Vet Med Sci. 2018;80(4):620-8.
Engelke K. Quantitative computed tomography-current status and new developments. J Clin Densitom. 2017;20(3):309-21.
Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994;4(6):368-81.
LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022;33(10):2049-102.
Zhang S, Wu S, Xia B, et al. Association of coffee and tea consumption with osteoporosis risk: A prospective study from the UK biobank. Bone. 2024;186:117135.
Zhao H, Jia H, Jiang Y, et al. Associations of sleep behaviors and genetic risk with risk of incident osteoporosis: A prospective cohort study of 293,164 participants. Bone. 2024;186:117168.
Koh LK, Sedrine WB, Torralba TP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12(8):699-705.
Choi RY, Coyner AS, Kalpathy-Cramer J, Chiang MF, Campbell JP. Introduction to machine learning, neural networks, and deep learning. Transl Vis Sci Technol. 2020;9(2):14.
Mintz Y, Brodie R. Introduction to artificial intelligence in medicine. Minim Invasive Ther Allied Technol. 2019;28(2):73-81.
Pickhardt PJ, Nguyen T, Perez AA, et al. Improved CT-based osteoporosis assessment with a fully automated deep learning tool. Radiol Artif Intell. 2022;4(5):e220042.
Chen YC, Li YT, Kuo PC, et al. Automatic segmentation and radiomic texture analysis for osteoporosis screening using chest low-dose computed tomography. Eur Radiol. 2023;33(7):5097-106.
Yang Q, Cheng H, Qin J, et al. A machine learning-based preclinical osteoporosis screening tool (POST): Model development and validation study. JMIR Aging. 2023;6:e46791.
Qiu C, Su K, Luo Z, et al. Developing and comparing deep learning and machine learning algorithms for osteoporosis risk prediction. Front Artif Intell. 2024;7:1355287.
Anthamatten A, Parish A. Clinical update on osteoporosis. J Midwifery Women's Health. 2019;64(3):265-75.
Sedrine WB, Chevallier T, Zegels B, et al. Development and assessment of the osteoporosis index of risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol. 2002;16(3):245-50.
Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care. 1998;4(1):37-48.
Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162(9):1289-94.
Badillo S, Banfai B, Birzele F, et al. An introduction to machine learning. Clin Pharmacol Ther. 2020;107(4):871-85.
Kim SK, Yoo TK, Oh E, Kim DW. Osteoporosis risk prediction using machine learning and conventional methods. Annu Int Conf IEEE Eng Med Biol Soc. 2013;2013:188-91.
Shim JG, Kim DW, Ryu KH, et al. Application of machine learning approaches for osteoporosis risk prediction in postmenopausal women. Arch Osteoporos. 2020;15(1):169.
Meng J, Sun N, Chen Y, et al. Artificial neural network optimizes self-examination of osteoporosis risk in women. J Int Med Res. 2019;47(7):3088-98.
Ou Yang WY, Lai CC, Tsou MT, Hwang LC. Development of machine learning models for prediction of osteoporosis from clinical health examination data. Int J Environ Res Public Health. 2021;18(14).
Chiu CT, Lee JI, Lu CC, Huang SP, Chen SC, Geng JH. The association between body mass index and osteoporosis in a Taiwanese population: a cross-sectional and longitudinal study. Sci Rep. 2024;14(1):8509.
Montanari NR, Ramírez R, Aggarwal A, et al. Multi-parametric analysis of human livers reveals variation in intrahepatic inflammation across phases of chronic hepatitis B infection. J Hepatol. 2022;77(2):332-43.
Zheng X-Q, Lin J-L, Huang J, Wu T, Song C-L. Targeting aging with the healthy skeletal system: The endocrine role of bone. Rev Endocr Metab Disord. 2023;24(4):695-711.
Leung KS, Fung KP, Sher AH, Li CK, Lee KM. Plasma bone-specific alkaline phosphatase as an indicator of osteoblastic activity. J Bone Joint Surg Br. 1993;75(2):288-92.
Huh JH, Choi SI, Lim JS, Chung CH, Shin JY, Lee MY. Lower serum creatinine is associated with low bone mineral density in subjects without overt nephropathy. PLoS One. 2015;10(7):e0133062.
Yan DD, Wang J, Hou XH, et al. Association of serum uric acid levels with osteoporosis and bone turnover markers in a Chinese population. Acta Pharmacol Sin. 2018;39(4):626-32.
Lian XL, Zhang YP, Li X, Jing LD, Cairang ZM, Gou JQ. Exploration of the relationship between elderly osteoporosis and cardiovascular disease risk factors. Eur Rev Med Pharmacol Sci. 2017;21(19):4386-90.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Bohan Li, Dongjin Wu, Xiaoqian Kong, Yan Shi, Chunzheng Gao, Yixin Li

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
The authors who publish in this journal agree to the following requirements:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.