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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Early identification of abnormal bone mineral density (BMD) through opportunistic screening is critical for preventing osteoporotic fractures. We validated an AI model in 2384 asymptomatic adults (57.7% female; mean age 43.6 years) undergoing health examinations in Taiwan. Using DXA as the reference, the model identified 255 suspected abnormal BMD cases, with 94 (3.9%) DXA-confirmed positive. Population-level performance was robust, yielding an AUC of 0.95 (95% CI 0.93\u20130.99) and sensitivity of 79.7% (95% CI 71.3\u201386.5%). Although BMI distributions paralleled East Asian regional trends, intersectional subgroup analyses remain exploratory due to small event counts. Decision curve analysis indicated superior net benefit for AI-based referral over \u201crefer all\u201d or \u201crefer none\u201d strategies, particularly for women with normal BMI (18.5\u201323\u2009kg\/m\u00b2). This AI tool offers precise triage for Asian health examination populations, though further validation in multi-center cohorts is required to confirm broad generalizability.<\/jats:p>","DOI":"10.1038\/s41746-026-02484-x","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T08:25:16Z","timestamp":1773908716000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Advancing diagnostic equity through artificial intelligence chest radiograph screening for osteoporosis in Asian populations"],"prefix":"10.1038","volume":"9","author":[{"given":"Shu-Han","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray-E","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-En","family":"Lien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dun-Jhu","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Lu","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Hui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2484_CR1","unstructured":"World Health Organization (WHO). 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C.-E.L. is an employee of Acer Medical Inc. D.-J.Y. is an employee of Acer Inc. All other authors declare no competing interests. The study was independently designed and conducted by the clinical team. Commercial collaborators had no role in the study design, data collection, analysis, interpretation, or manuscript preparation.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"359"}}