{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:00:52Z","timestamp":1788930052848,"version":"build-2803163510"},"reference-count":60,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Bone Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Standard clinical imaging metrics perform poorly in predicting skeletal fragility in chronic kidney disease (CKD), particularly due to the complex and heterogeneous cortical deterioration that characterizes advanced disease. Here, this study aimed to identify radiomic features derived from high-resolution peripheral quantitative computed tomography (HR-pQCT) in tibial cortical bone that distinguish CKD-related differences and may serve as markers of subtle cortical alterations undetected by conventional imaging. HR-pQCT image stacks were obtained from 72 participants (38 non-CKD and 34 with CKD stage 5D) at 7.3% (distal) and 30% (diaphyseal) proximally from the tibial endplate, resulting in a total of 24 192 slices. In non-CKD cases, features were largely derived from first-order statistics, while complex features from higher-order statistics were more prominent in CKD cases. Although conventional HR-pQCT outcomes, such as volumetric bone mineral density, showed limited ability to differentiate CKD from non-CKD cortical bone in our population of stage 5D patients, the top features, such as Minimum and Strength, provided a significant distinction between the two groups (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, Effect size\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u2009from 0.813 to 0.856). Our findings demonstrate that radiomic analysis identifies cortical bone differences associated with CKD that were not distinguished by conventional HR-pQCT metrics, highlighting its potential to improve bone quality assessment in this high-risk population.\n                  <\/jats:p>","DOI":"10.1038\/s41413-026-00515-7","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:35:40Z","timestamp":1775100940000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Radiomics identifies distinct cortical bone texture alterations in patients with CKD using HR-pQCT"],"prefix":"10.1038","volume":"14","author":[{"given":"Youngjun","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seokkyoon","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miran","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choongbeom","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangjun","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon M.","family":"Moe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart J.","family":"Warden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7614-4412","authenticated-orcid":false,"given":"Rachel K.","family":"Surowiec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"515_CR1","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s11255-010-9723-x","volume":"43","author":"C Ambrus","year":"2011","unstructured":"Ambrus, C. et al. Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis. Int. Urol. Nephrol. 43, 475\u2013482 (2011).","journal-title":"Int. Urol. Nephrol."},{"key":"515_CR2","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1046\/j.1523-1755.2000.00178.x","volume":"58","author":"AM Alem","year":"2000","unstructured":"Alem, A. M. et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 58, 396\u2013399 (2000).","journal-title":"Kidney Int."},{"key":"515_CR3","first-page":"45","volume":"3","author":"A Sidib\u00e9","year":"2019","unstructured":"Sidib\u00e9, A. et al. Fracture risk in dialysis and kidney transplanted patients: a systematic review. J. Bone Miner. Res. 3, 45\u201355 (2019).","journal-title":"J. Bone Miner. Res."},{"key":"515_CR4","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.2215\/CJN.09500916","volume":"11","author":"SM Moe","year":"2016","unstructured":"Moe, S. M. & Nickolas, T. L. Fractures in patients with CKD: time for action. Clin. J. Am. Soc. Nephrol. 11, 1929\u20131931 (2016).","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"515_CR5","doi-asserted-by":"publisher","first-page":"101612","DOI":"10.1016\/j.bonr.2022.101612","volume":"17","author":"CE Metzger","year":"2022","unstructured":"Metzger, C. E. et al. Cortical porosity occurs at varying degrees throughout the skeleton in rats with chronic kidney disease. Bone Rep. 17, 101612 (2022).","journal-title":"Bone Rep."},{"key":"515_CR6","doi-asserted-by":"publisher","first-page":"2325","DOI":"10.1093\/ndt\/gfg403","volume":"18","author":"P Urena","year":"2003","unstructured":"Urena, P. et al. Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol. Dialysis Transplant. 18, 2325\u20132331 (2003).","journal-title":"Nephrol. Dialysis Transplant."},{"key":"515_CR7","first-page":"57","volume":"30","author":"B Piraino","year":"1988","unstructured":"Piraino, B., Chen, T., Cooperstein, L., Segre, G. & Puschett, J. Fractures and vertebral bone mineral density in patients with renal osteodystrophy. Clin. Nephrol. 30, 57\u201362 (1988).","journal-title":"Clin. Nephrol."},{"key":"515_CR8","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1002\/jbmr.1916","volume":"28","author":"TL Nickolas","year":"2013","unstructured":"Nickolas, T. L. et al. Rapid cortical bone loss in patients with chronic kidney disease. J. Bone Miner. Res. 28, 1811\u20131820 (2013).","journal-title":"J. Bone Miner. Res."},{"key":"515_CR9","doi-asserted-by":"publisher","first-page":"e99262","DOI":"10.1371\/journal.pone.0099262","volume":"9","author":"CL Newman","year":"2014","unstructured":"Newman, C. L. et al. Cortical bone mechanical properties are altered in an animal model of progressive chronic kidney disease. PLoS One 9, e99262 (2014).","journal-title":"PLoS One"},{"key":"515_CR10","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1007\/s00198-012-2133-4","volume":"24","author":"A Trombetti","year":"2013","unstructured":"Trombetti, A. et al. Alterations of bone microstructure and strength in end-stage renal failure. Osteoporos. Int. 24, 1721\u20131732 (2013).","journal-title":"Osteoporos. Int."},{"key":"515_CR11","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1681\/ASN.2009121208","volume":"21","author":"TL Nickolas","year":"2010","unstructured":"Nickolas, T. L. et al. Bone mass and microarchitecture in CKD patients with fracture. J. Am. Soc. Nephrol. 21, 1371\u20131380 (2010).","journal-title":"J. Am. Soc. Nephrol."},{"key":"515_CR12","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1007\/s00198-020-05458-1","volume":"31","author":"C Rampersad","year":"2020","unstructured":"Rampersad, C. et al. Trabecular bone score in patients with chronic kidney disease. Osteoporos. Int. 31, 1905\u20131912 (2020).","journal-title":"Osteoporos. Int."},{"key":"515_CR13","doi-asserted-by":"publisher","first-page":"e1534","DOI":"10.1210\/clinem\/dgad724","volume":"109","author":"F Bioletto","year":"2024","unstructured":"Bioletto, F. et al. Trabecular bone score as a marker of skeletal fragility across the spectrum of chronic kidney disease: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 109, e1534\u2013e1543 (2024).","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"515_CR14","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.bone.2018.08.006","volume":"116","author":"J Ramalho","year":"2018","unstructured":"Ramalho, J. et al. The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease. Bone 116, 215\u2013220 (2018).","journal-title":"Bone"},{"key":"515_CR15","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/S8756-3282(96)00246-3","volume":"19","author":"T Yamaguchi","year":"1996","unstructured":"Yamaguchi, T. et al. Retrospective study on the usefulness of radius and lumbar bone density in the separation of hemodialysis patients with fractures from those without fractures. Bone 19, 549\u2013555 (1996).","journal-title":"Bone"},{"key":"515_CR16","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1002\/jbmr.3901","volume":"35","author":"N Mikolajewicz","year":"2020","unstructured":"Mikolajewicz, N. et al. HR-pQCT measures of bone microarchitecture predict fracture: systematic review and meta-analysis. J. Bone Miner. Res. 35, 446\u2013459 (2020).","journal-title":"J. Bone Miner. Res."},{"key":"515_CR17","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s11914-013-0140-9","volume":"11","author":"AM Cheung","year":"2013","unstructured":"Cheung, A. M. et al. High-resolution peripheral quantitative computed tomography for the assessment of bone strength and structure: a review by the Canadian Bone Strength Working Group. Curr. Osteoporos. Rep. 11, 136\u2013146 (2013).","journal-title":"Curr. Osteoporos. Rep."},{"key":"515_CR18","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/s11914-015-0262-3","volume":"13","author":"SA Jamal","year":"2015","unstructured":"Jamal, S. A. & Nickolas, T. L. Bone imaging and fracture risk assessment in kidney disease. Curr. Osteoporos. Rep. 13, 166\u2013172 (2015).","journal-title":"Curr. Osteoporos. Rep."},{"key":"515_CR19","doi-asserted-by":"publisher","first-page":"116260","DOI":"10.1016\/j.bone.2021.116260","volume":"154","author":"A Ghasem-Zadeh","year":"2022","unstructured":"Ghasem-Zadeh, A. et al. Bone microarchitecture and estimated failure load are deteriorated whether patients with chronic kidney disease have normal bone mineral density, osteopenia or osteoporosis. Bone 154, 116260 (2022).","journal-title":"Bone"},{"key":"515_CR20","doi-asserted-by":"publisher","first-page":"2955","DOI":"10.1007\/s00198-016-3621-8","volume":"27","author":"S Agarwal","year":"2016","unstructured":"Agarwal, S. et al. In vivo assessment of bone structure and estimated bone strength by first- and second-generation HR-pQCT. Osteoporos. Int. 27, 2955\u20132966 (2016).","journal-title":"Osteoporos. Int."},{"key":"515_CR21","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1093\/jbmr\/zjaf006","volume":"40","author":"M Zhou","year":"2025","unstructured":"Zhou, M. et al. Time-lapse HR-pQCT reliably assesses and monitors local bone turnover in patients with chronic kidney disease. J. Bone Miner. Res 40, 738\u2013752 (2025).","journal-title":"J. Bone Miner. Res"},{"key":"515_CR22","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1080\/0886022X.2022.2043375","volume":"44","author":"K Tsuji","year":"2022","unstructured":"Tsuji, K. et al. Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis. Ren. Fail. 44, 381\u2013391 (2022).","journal-title":"Ren. Fail."},{"key":"515_CR23","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s11914-017-0366-z","volume":"15","author":"EM McNerny","year":"2017","unstructured":"McNerny, E. M. & Nickolas, T. L. Bone quality in chronic kidney disease: definitions and diagnostics. Curr. Osteoporos. Rep. 15, 207\u2013213 (2017).","journal-title":"Curr. Osteoporos. Rep."},{"key":"515_CR24","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1118\/1.3528125","volume":"38","author":"P Ranjanomennahary","year":"2011","unstructured":"Ranjanomennahary, P. et al. Comparison of radiograph-based texture analysis and bone mineral density with three-dimensional microarchitecture of trabecular bone. Med. Phys. 38, 420\u2013428 (2011).","journal-title":"Med. Phys."},{"key":"515_CR25","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/s00774-012-0375-z","volume":"31","author":"T Le Corroller","year":"2013","unstructured":"Le Corroller, T. et al. Bone texture analysis is correlated with three-dimensional microarchitecture and mechanical properties of trabecular bone in osteoporotic femurs. J. Bone Miner. Metab. 31, 82\u201388 (2013).","journal-title":"J. Bone Miner. Metab."},{"key":"515_CR26","doi-asserted-by":"publisher","first-page":"8019","DOI":"10.1007\/s00330-022-08805-4","volume":"32","author":"YW Jiang","year":"2022","unstructured":"Jiang, Y. W., Xu, X. J., Wang, R. & Chen, C. M. Radiomics analysis based on lumbar spine CT to detect osteoporosis. Eur. Radio. 32, 8019\u20138026 (2022).","journal-title":"Eur. Radio."},{"key":"515_CR27","doi-asserted-by":"publisher","first-page":"101821","DOI":"10.1016\/j.bonr.2024.101821","volume":"24","author":"Y Lee","year":"2025","unstructured":"Lee, Y. et al. Integrating deep learning and machine learning for improved CKD-related cortical bone assessment in HRpQCT images: A pilot study. Bone Rep. 24, 101821 (2025).","journal-title":"Bone Rep."},{"key":"515_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-022-06096-w","volume":"24","author":"J Wang","year":"2023","unstructured":"Wang, J. et al. Prediction of osteoporosis using radiomics analysis derived from single source dual energy CT. BMC Musculoskelet. Disord. 24, 100 (2023).","journal-title":"BMC Musculoskelet. Disord."},{"key":"515_CR29","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1007\/s00198-019-04910-1","volume":"30","author":"A Valentinitsch","year":"2019","unstructured":"Valentinitsch, A. et al. Opportunistic osteoporosis screening in multi-detector CT images via local classification of textures. Osteoporos. Int. 30, 1275\u20131285 (2019).","journal-title":"Osteoporos. Int."},{"key":"515_CR30","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.ejrad.2019.05.009","volume":"116","author":"Y Kawashima","year":"2019","unstructured":"Kawashima, Y. et al. Using texture analysis of head CT images to differentiate osteoporosis from normal bone density. Eur. J. Radiol. 116, 212\u2013218 (2019).","journal-title":"Eur. J. Radiol."},{"key":"515_CR31","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.jmir.2019.11.006","volume":"51","author":"S Rastegar","year":"2020","unstructured":"Rastegar, S. et al. Radiographic image radiomics feature reproducibility: a preliminary study on the impact of field size. J. Med. Imaging Radiat. Sci. 51, 128\u2013136 (2020).","journal-title":"J. Med. Imaging Radiat. Sci."},{"key":"515_CR32","doi-asserted-by":"publisher","first-page":"2250","DOI":"10.1056\/NEJMra053077","volume":"354","author":"E Seeman","year":"2006","unstructured":"Seeman, E. & Delmas, P. D. Bone quality\u2014the material and structural basis of bone strength and fragility. N. Engl. J. Med. 354, 2250\u20132261 (2006).","journal-title":"N. Engl. J. Med."},{"key":"515_CR33","doi-asserted-by":"publisher","first-page":"101161","DOI":"10.1016\/j.bonr.2021.101161","volume":"16","author":"RK Surowiec","year":"2022","unstructured":"Surowiec, R. K., Allen, M. R. & Wallace, J. M. Bone hydration: How we can evaluate it, what can it tell us, and is it an effective therapeutic target. Bone Rep. 16, 101161 (2022).","journal-title":"Bone Rep."},{"key":"515_CR34","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s11914-018-0433-0","volume":"16","author":"M Unal","year":"2018","unstructured":"Unal, M., Creecy, A. & Nyman, J. S. The Role of Matrix Composition in the Mechanical Behavior of Bone. Curr. Osteoporos. Rep. 16, 205\u2013215 (2018).","journal-title":"Curr. Osteoporos. Rep."},{"key":"515_CR35","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.ebiom.2019.08.059","volume":"48","author":"JC Peeken","year":"2019","unstructured":"Peeken, J. C. et al. Tumor grading of soft tissue sarcomas using MRI-based radiomics. eBioMedicine 48, 332\u2013340 (2019).","journal-title":"eBioMedicine"},{"key":"515_CR36","doi-asserted-by":"publisher","first-page":"3961","DOI":"10.1007\/s00259-021-05242-1","volume":"48","author":"G Wu","year":"2021","unstructured":"Wu, G. et al. Structural and functional radiomics for lung cancer. Eur. J. Nucl. Med. Mol. Imaging 48, 3961\u20133974 (2021).","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"515_CR37","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1148\/radiol.2018180946","volume":"290","author":"HC Kniep","year":"2019","unstructured":"Kniep, H. C. et al. Radiomics of brain MRI: utility in prediction of metastatic tumor type. Radiology 290, 479\u2013487 (2019).","journal-title":"Radiology"},{"key":"515_CR38","doi-asserted-by":"publisher","first-page":"109043","DOI":"10.1016\/j.ejrad.2020.109043","volume":"128","author":"S Gitto","year":"2020","unstructured":"Gitto, S. et al. MRI radiomics-based machine-learning classification of bone chondrosarcoma. Eur. J. Radiol. 128, 109043 (2020).","journal-title":"Eur. J. Radiol."},{"key":"515_CR39","doi-asserted-by":"crossref","unstructured":"Valentinitsch, A., Patsch, J., Mueller, D., Kainberger, F. & Langs, G. in 2010 IEEE international symposium on biomedical imaging: from nano to macro. 1361\u20131364 (IEEE).","DOI":"10.1109\/ISBI.2010.5490250"},{"key":"515_CR40","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1007\/s00198-023-06817-4","volume":"34","author":"E Shevroja","year":"2023","unstructured":"Shevroja, E. et al. Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporos. Int. 34, 1501\u20131529 (2023).","journal-title":"Osteoporos. Int."},{"key":"515_CR41","doi-asserted-by":"publisher","first-page":"104409","DOI":"10.1016\/j.compbiomed.2021.104409","volume":"133","author":"S Amiri","year":"2021","unstructured":"Amiri, S. et al. Radiomics analysis on CT images for prediction of radiation-induced kidney damage by machine learning models. Computers Biol. Med. 133, 104409 (2021).","journal-title":"Computers Biol. Med."},{"key":"515_CR42","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.acra.2021.01.006","volume":"29","author":"MS Bandara","year":"2022","unstructured":"Bandara, M. S. et al. Ultrasound based radiomics features of chronic kidney disease. Academic Radiol. 29, 229\u2013235 (2022).","journal-title":"Academic Radiol."},{"key":"515_CR43","doi-asserted-by":"publisher","first-page":"101169","DOI":"10.1016\/j.bonr.2022.101169","volume":"16","author":"LS Campagnaro","year":"2022","unstructured":"Campagnaro, L. S., Carvalho, A. B., Pina, P. M., Watanabe, R. & Canziani, M. E. F. Bone mass measurement by DXA should be interpreted with caution in the CKD population with vascular calcification. Bone Rep. 16, 101169 (2022).","journal-title":"Bone Rep."},{"key":"515_CR44","doi-asserted-by":"publisher","first-page":"ziae095","DOI":"10.1093\/jbmrpl\/ziae095","volume":"8","author":"FI Nissen","year":"2024","unstructured":"Nissen, F. I., Esser, V. F., Bj\u00f8rnerem, \u00c5. & Hansen, A. K. Causal relationships between height and weight with distal tibia microarchitecture and geometry in adult female twin pairs. JBMR Plus 8, ziae095 (2024).","journal-title":"JBMR Plus"},{"key":"515_CR45","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s00198-021-06164-2","volume":"33","author":"SJ Warden","year":"2022","unstructured":"Warden, S. J., Liu, Z., Fuchs, R. K., van Rietbergen, B. & Moe, S. M. Reference data and calculators for second-generation HR-pQCT measures of the radius and tibia at anatomically standardized regions in White adults. Osteoporos. Int. 33, 791\u2013806 (2022).","journal-title":"Osteoporos. Int."},{"key":"515_CR46","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1053\/j.ajkd.2010.02.340","volume":"55","author":"K Uhlig","year":"2010","unstructured":"Uhlig, K. et al. KDOQI US commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation, and treatment of CKD\u2013mineral and bone disorder (CKD-MBD). Am. J. Kidney Dis. 55, 773\u2013799 (2010).","journal-title":"Am. J. Kidney Dis."},{"key":"515_CR47","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1053\/j.ajkd.2017.07.019","volume":"70","author":"T Isakova","year":"2017","unstructured":"Isakova, T. et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease\u2013mineral and bone disorder (CKD-MBD). Am. J. Kidney Dis. 70, 737\u2013751 (2017).","journal-title":"Am. J. Kidney Dis."},{"key":"515_CR48","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline forthe diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Supplement, S1\u2013130 (2009)."},{"key":"515_CR49","doi-asserted-by":"crossref","first-page":"i\u2013S201","DOI":"10.1016\/j.ajkd.2003.07.010","volume":"42","author":"SG Massry","year":"2003","unstructured":"Massry, S. G. et al. K\/DOQI clinical practice guidelines for bone metabolism and disease in chronickidney disease. Am. J. Kidney Dis. 42, i\u2013S201 (2003).","journal-title":"Am. J. Kidney Dis."},{"key":"515_CR50","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-07178-4","volume":"12","author":"Y Kim","year":"2022","unstructured":"Kim, Y., Lee, E., Lee, M.-J., Park, B. & Park, I. Characteristics of fracture in patients who firstly starts kidney replacement therapy in Korea: a retrospective population-based study. Sci. Rep. 12, 3107 (2022).","journal-title":"Sci. Rep."},{"key":"515_CR51","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.bone.2011.10.003","volume":"50","author":"J Pialat","year":"2012","unstructured":"Pialat, J., Burghardt, A., Sode, M., Link, T. & Majumdar, S. Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone 50, 111\u2013118 (2012).","journal-title":"Bone"},{"key":"515_CR52","doi-asserted-by":"crossref","unstructured":"Warden SJ, Liu Z, Fuchs RK, van Rietbergen B, Moe SM. Reference data and calculators for second-generation HR-pQCT measures of the radius and tibia at anatomically standardized regions in White adults. Osteoporos Int. 33, 791-806 (2022).","DOI":"10.1007\/s00198-021-06164-2"},{"key":"515_CR53","doi-asserted-by":"publisher","first-page":"e104","DOI":"10.1158\/0008-5472.CAN-17-0339","volume":"77","author":"JJ Van Griethuysen","year":"2017","unstructured":"Van Griethuysen, J. J. et al. Computational radiomics system to decode the radiographic phenotype. Cancer Res. 77, e104\u2013e107 (2017).","journal-title":"Cancer Res."},{"key":"515_CR54","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1148\/radiol.2020191145","volume":"295","author":"A Zwanenburg","year":"2020","unstructured":"Zwanenburg, A. et al. The image biomarker standardization initiative: standardized quantitative radiomics for high-throughput image-based phenotyping. Radiology 295, 328\u2013338 (2020).","journal-title":"Radiology"},{"key":"515_CR55","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms5006","volume":"5","author":"HJ Aerts","year":"2014","unstructured":"Aerts, H. J. et al. Decoding tumour phenotype by noninvasive imaging using a quantitative radiomics approach. Nat. Commun. 5, 4006 (2014).","journal-title":"Nat. Commun."},{"key":"515_CR56","first-page":"2825","volume":"12","author":"F Pedregosa","year":"2011","unstructured":"Pedregosa, F. et al. Scikit-learn: machine learning in Python. J. Mach. Learn. Res. 12, 2825\u20132830 (2011).","journal-title":"J. Mach. Learn. Res."},{"key":"515_CR57","first-page":"1","volume":"14","author":"W McKinney","year":"2011","unstructured":"McKinney, W. pandas: a foundational Python library for data analysis and statistics. Python high. Perform. Sci. Comput. 14, 1\u20139 (2011).","journal-title":"Python high. Perform. Sci. Comput."},{"key":"515_CR58","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1007\/s00198-020-05438-5","volume":"31","author":"DE Whittier","year":"2020","unstructured":"Whittier, D. E. et al. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos. Int. 31, 1607\u20131627 (2020).","journal-title":"Osteoporos. Int."},{"key":"515_CR59","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/j.bone.2008.01.017","volume":"42","author":"JA MacNeil","year":"2008","unstructured":"MacNeil, J. A. & Boyd, S. K. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone 42, 1203\u20131213 (2008).","journal-title":"Bone"},{"key":"515_CR60","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1007\/s40279-014-0185-7","volume":"44","author":"E Zemkov\u00e1","year":"2014","unstructured":"Zemkov\u00e1, E. Significantly and practically meaningful differences in balance research: P values and\/or effect sizes?. Sports Med. 44, 879\u2013886 (2014).","journal-title":"Sports Med."}],"container-title":["Bone Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41413-026-00515-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41413-026-00515-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41413-026-00515-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:11:16Z","timestamp":1775106676000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41413-026-00515-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":60,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["515"],"URL":"https:\/\/doi.org\/10.1038\/s41413-026-00515-7","relation":{},"ISSN":["2095-6231"],"issn-type":[{"value":"2095-6231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"assertion":[{"value":"11 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36"}}