{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:40:39Z","timestamp":1792658439923,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1187","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018853","name":"The Prince Charles Hospital Foundation","doi-asserted-by":"publisher","award":["NI2021-09"],"award-info":[{"award-number":["NI2021-09"]}],"id":[{"id":"10.13039\/501100018853","id-type":"DOI","asserted-by":"publisher"}]},{"name":"International Lung Screening Trial"},{"name":"National Health & Medical Research Council Grant","award":["APP1099154"],"award-info":[{"award-number":["APP1099154"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lung cancer screening (LCS) participants are \u201chigh-risk\u201d for osteoporotic fracture. We compared lumbar vertebral Hounsfield unit CT-attenuation (VHU) from LCS images with standard dual-energy X-ray absorptiometry (DXA), quantitative CT (QCT) and clinical fracture risk tools to identify participants with low bone mineral density (BMD), prevalent vertebral fracture (VF) and incident osteoporotic fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>LCS participants were cross-sectionally analyzed at a 2-year follow-up time point. BMD was assessed from paired LCS chest low-dose CT (VHU and spine QCT) and DXA scans (T-scores). FRAX and Garvan 10-year fracture risks were calculated from questionnaires. VFs were assessed semi-quantitatively from CT scans; 2-year incident VFs were identified by comparing baseline and 2-year follow-up CT scans. Participants self-reported 2-year incident osteoporotic fractures. Method discrimination for low DXA-BMD (T-score\u2009&amp;lt;\u2009\u22121), prevalent VFs and incident fractures was compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 91 participants (M:F\u2009=\u20090.75), VHU moderately discriminated low DXA-BMD moderately (AUC, 0.74), similar to QCT (AUC, 0.73), FRAX (AUC, 0.82) and Garvan (AUC, 0.78) (P\u2009&amp;gt;\u2009.05). VHU performed similarly to DXA spine T-score, QCT, FRAX, and Garvan in discrimination for both prevalent VF (AUC, 0.71) and incident fractures (AUC, 0.71). Correlation and inter-method reliability between VHU and DXA-T-scores were fair (R\u2009=\u20090.42, \u0138\u2009&amp;lt;\u20090.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In LCS, VHU is a convenient alternative to case-finding screenees with occult osteoporosis, having comparable discrimination to standard methods for low BMD and osteoporotic fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>Within-population comparison of osteoporosis assessment methods, shows that VHU can comparably \u201ccase-find\u201d LCS participants with occult osteoporotic disease and incident fractures, warranting larger prospective studies.<\/jats:p>\n                  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