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From a total of 219 patients diagnosed with PHP, the 58 who had undergone both DXA and abdominal CT scan were included in this study. BMD was assessed by quantifying the Hounsfield units (HU) and performing texture analysis on every CT scan. The first lumbar vertebral body texture features were extracted by using LifeX 7.3.0 software. Initial classification into normal or abnormal BMD was performed with different machine learning techniques by training a model with the variables obtained from the texture analysis. Differentiating osteopenia from osteoporosis was evaluated by creating two models, one including the variables obtained from the texture analysis and HU and another one which only included the HU. Their performance was evaluated in the validation and test groups by calculating the accuracy, precision, recall, F1 score, and AUC. Bayes demonstrated higher performance for discerning individuals with normal and abnormal BMD, with an AUC of 0.916. The results from the second analysis showed a better performance for the model including the variables obtained from the texture analysis compared to the model that was solely trained with the HU (AUC in the training group of 0.77 vs. 0.65 in the test groups, respectively). In conclusion, analysis of BMD obtained from abdominal CT scans including texture analysis provide a better classification of normal density, osteopenia and osteoporosis in patients with PHP.<\/jats:p>","DOI":"10.1007\/s11547-025-02004-z","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T04:02:18Z","timestamp":1745467338000},"page":"1084-1091","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Advanced radiomic prediction of osteoporosis in primary hyperparathyroidism: a machine learning-based analysis of CT images"],"prefix":"10.1007","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1539-057X","authenticated-orcid":false,"given":"Antonio","family":"Adarve-Castro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3285-7194","authenticated-orcid":false,"given":"Virginia","family":"Soria-Utrilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4412-0149","authenticated-orcid":false,"given":"Jos\u00e9 Miguel","family":"Castro-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-4975","authenticated-orcid":false,"given":"Mar\u00eda Dolores","family":"Dom\u00ednguez-Pinos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9535-9806","authenticated-orcid":false,"given":"Francisco","family":"Sendra-Portero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4630-7588","authenticated-orcid":false,"given":"Miguel J.","family":"Ruiz-G\u00f3mez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Algarra-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2004_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10482","author":"N Narayanan","year":"2021","unstructured":"Narayanan N, Palui R, Merugu C, Kar SS, Kamalanathan S, Sahoo J et al (2021) The risk of fractures in primary hyperparathyroidism: a meta analysis. 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The study was approved by the Research Ethics Committee provincial of M\u00e1laga (reference number SICEIA-2024-001104).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}