{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:24:38Z","timestamp":1787009078802,"version":"build-2736575974"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Canadian Multicentre Osteoporosis Study"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Amgen Canada Inc."},{"name":"Actavis Pharma Inc."},{"DOI":"10.13039\/100010710","name":"Dairy Farmers of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019518","name":"Eli Lilly Canada Inc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019518","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sanofi-Aventis Canada Inc."},{"DOI":"10.13039\/501100023798","name":"Servier Canada Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023798","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000142","name":"The Arthritis Society","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000142","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fracture risk is commonly assessed by FRAX, a tool that estimates 10-yr risk for major osteoporotic fracture (MOF) and hip fracture. FRAX scores are often refined by including FN BMD measured by DXA as an input. Rho, a novel AI-powered software, estimates FN BMD T-Scores from conventional X-rays, even when FN is not in the image. Whether a FRAX score using this estimate (FRAX-Rho) can improve a FRAX score without a T-Score input (FRAX-NoT) has not been studied. We conducted a retrospective analysis of Canadian Multicentre Osteoporosis Study participants who had X-rays of the lumbar and\/or thoracic spine, FRAX risk factors, and DXA T-Scores acquired at the same time point, and follow-up fracture outcomes over 9\u00a0yr. In 1361 participants with lumbar X-rays, FRAX-Rho and FRAX with DXA FN T-Scores (FRAX-DXA) had very good agreement in categorizing participants by MOF risk (Cohen\u2019s weighted kappa \u03ba\u2009=\u20090.80 [0.77-0.82]), which tended to be better than that between FRAX-NoT and FRAX-DXA (0.76 [0.73-0.79]). Agreement in categorizing participants by hip fracture risk was significantly greater between FRAX-Rho and FRAX-DXA (0.67 [0.63-0.71]) than FRAX-NoT and FRAX-DXA (0.52 [0.48-0.56]). In predicting true incident MOF, FRAX-Rho and FRAX-DXA did not differ in their discriminative power (c-index) (0.76 and 0.77; p\u2009=\u2009.36); both were significantly greater than that of FRAX-NoT (0.73; p\u00a0&amp;lt;\u2009.004). The accuracy of FRAX-Rho for predicting MOF (Brier Score) was better than FRAX-NoT (p\u00a0&amp;lt;\u2009.05) but not as good as FRAX-DXA. Similar results were observed in participants with thoracic X-rays. In conclusion, FN T-Scores estimated by Rho from lumbar and thoracic X-rays add value to FRAX-NoT estimates and may be useful for risk assessment when DXA is not available.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf113","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T11:11:32Z","timestamp":1755601892000},"page":"120-127","source":"Crossref","is-referenced-by-count":2,"title":["Fracture risk scores using output from an opportunistic screen of low bone density from conventional X-ray"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-4410","authenticated-orcid":false,"given":"Catriona A","family":"Syme","sequence":"first","affiliation":[{"name":"Department of Research, 16 Bit Inc. , Toronto, ON , M5J 2N8","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D","family":"Cicero","sequence":"additional","affiliation":[{"name":"Department of Research, 16 Bit Inc. , Toronto, ON , M5J 2N8","place":["Canada"]},{"name":"Diagnostic Radiology, True North Imaging , Toronto, ON ,","place":["L4J 7Y7 Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D","family":"Adachi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, McMaster University , Hamilton, ON , L8N 3Z5","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudie","family":"Berger","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre , Montreal, QC ,","place":["H3H 2R9 Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4317-492X","authenticated-orcid":false,"given":"Suzanne N","family":"Morin","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre , Montreal, QC ,","place":["H3H 2R9 Canada"]},{"name":"Department of Medicine, McGill University , Montreal, QC ,","place":["H4A 3J1 Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Goltzman","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre , Montreal, QC ,","place":["H3H 2R9 Canada"]},{"name":"Department of Medicine, McGill University , Montreal, QC ,","place":["H4A 3J1 Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Bilbily","sequence":"additional","affiliation":[{"name":"Department of Research, 16 Bit Inc. , Toronto, ON , M5J 2N8","place":["Canada"]},{"name":"Sunnybrook Health Sciences Centre, University of Toronto , Toronto, ON ,","place":["M4N 3M5 Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"2026020308314910900_ref1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00198-007-0543-5","article-title":"FRAX and the assessment of fracture probability in men and women from the UK","volume":"19","author":"Kanis","year":"2008","journal-title":"Osteoporos Int"},{"key":"2026020308314910900_ref2","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/s001980070064","article-title":"Long-term risk of osteoporotic fracture in Malm\u00f6","volume":"11","author":"Kanis","year":"2000","journal-title":"Osteoporos Int"},{"key":"2026020308314910900_ref3","doi-asserted-by":"crossref","first-page":"e580","DOI":"10.1016\/S2666-7568(21)00172-0","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the global burden of disease study 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fracture in obese older women","volume":"28","author":"Premaor","year":"2013","journal-title":"J Bone Miner Res"},{"key":"2026020308314910900_ref8","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.jacr.2023.07.024","article-title":"Opportunistic screening of low bone mineral density from standard X-rays","volume":"21","author":"Bilbily","year":"2024","journal-title":"J Am Coll Radiol"},{"key":"2026020308314910900_ref9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1017\/S0714980800009934","article-title":"Research notes: the Canadian multicentre osteoporosis study (CaMos): background, rationale, methods","volume":"18","author":"Kreiger","year":"1999","journal-title":"Canadian Journal on Aging \/ La Revue canadienne du vieillissement"},{"key":"2026020308314910900_ref10","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/BF02294215","article-title":"Sample size determinations for the two rater kappa 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