{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:56:15Z","timestamp":1791975375169,"version":"4.4.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Heart Foundation Future Leader Fellowship","award":["102817"],"award-info":[{"award-number":["102817"]}]},{"name":"Heart Foundation Postdoctoral Fellowship","award":["107194"],"award-info":[{"award-number":["107194"]}]},{"name":"Medical Research Future Fund 2022 Cardiovascular Health Mission Grant","award":["2024225"],"award-info":[{"award-number":["2024225"]}]},{"name":"Rady Innovation Fund"},{"name":"Rady Faculty of Health Sciences"},{"DOI":"10.13039\/100010318","name":"University of Manitoba","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Abdominal aortic calcification (AAC), a marker of subclinical cardiovascular disease, has previously shown to be associated with low BMD and fracture. However, it remains unclear whether AAC is associated with trabecular bone score (TBS), a gray-level textural measure, or whether it predicts fracture risk independent of this measure. Here, we examined the cross-sectional association of AAC scored using a validated machine learning algorithm (ML-AAC24) with TBS, and their simultaneous associations with incident fractures in 7691 individuals (93.4% women) through the Manitoba BMD Registry (mean age 75.3\u00a0yr). The association between ML-AAC24 and TBS was tested using generalized linear regression. Cox proportional hazards models tested the simultaneous relationships of ML-AAC24 and TBS with incident fractures. At baseline, 41.3% of the study cohort had low (&amp;lt;2), 32.4% had moderate (2 to &amp;lt;6), and 26.3% had high (\u22656) ML-AAC24. Compared to low ML-AAC24, high ML-AAC24 was associated with a 0.81% lower TBS in the multivariable-adjusted model. Independent of each other and multiple established fracture risk factors, ML-AAC24 and TBS were each associated with an increased risk of incident fractures. Specifically, high ML-AAC24 (HR 1.41, 95% CI: 1.15-1.73, compared to low ML-AAC24) and lower TBS (HR 1.13, 95% CI: 1.05-1.22, per SD decrease) were associated with increased relative hazards for any incident fracture. High ML-AAC24 and lower TBS were also associated with incident major osteoporotic fracture (HR 1.48, 95% CI: 1.18-1.87 and HR 1.15, 95% CI: 1.06-1.25, respectively) and hip fracture (HR 1.56, 95% CI: 1.05-2.31 and HR 1.25, 95% CI: 1.08-1.44, respectively). In conclusion, high ML-AAC24 is associated with lower TBS in older adults attending routine osteoporosis screening. Both measures were associated with incident fractures. The findings of this study highlight high ML-AAC24, seen in more than 1 in 4 of the study cohort, and lower TBS provide complementary prognostic information for fracture risk.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf144","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:14:00Z","timestamp":1760012040000},"page":"406-414","source":"Crossref","is-referenced-by-count":5,"title":["Automated abdominal aortic calcification and trabecular bone score independently predict incident fracture during routine osteoporosis screening"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1975-0085","authenticated-orcid":false,"given":"Abadi K","family":"Gebre","sequence":"first","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5166-0605","authenticated-orcid":false,"given":"Marc","family":"Sim","sequence":"additional","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]},{"name":"Medical School, The University of Western Australia , Perth, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Zulqarnain","family":"Gilani","sequence":"additional","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]},{"name":"Centre for AI and ML, School of Science, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]},{"name":"Department of Computer Science and Software Engineering, The University of Western Australia , Perth, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2517-2824","authenticated-orcid":false,"given":"Cassandra","family":"Smith","sequence":"additional","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]},{"name":"Medical School, The University of Western Australia , Perth, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Hans","sequence":"additional","affiliation":[{"name":"Bone and Joint Department, Lausanne University Hospital , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Concordia University , Montreal , QC, H3G 2W1,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9816-1747","authenticated-orcid":false,"given":"Barret A","family":"Monchka","sequence":"additional","affiliation":[{"name":"George and Fay Yee Centre for Healthcare Innovation, University of Manitoba , Winnipeg MBR3E 0T6,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Kimelman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg R2H 2A6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Jafari","family":"Jozani","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Manitoba , Winnipeg MB R3T 2M8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9329-0750","authenticated-orcid":false,"given":"John T","family":"Schousboe","sequence":"additional","affiliation":[{"name":"Park Nicollet Clinic and HealthPartners Institute, Health Partners , Minneapolis , MN 55416,","place":["United States"]},{"name":"Division of Health Policy and Management, University of Minnesota , Minneapolis , MN 55455,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R","family":"Lewis","sequence":"additional","affiliation":[{"name":"Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University , Perth, WA 6027 ,","place":["Australia"]},{"name":"Medical School, The University of Western Australia , Perth, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1056-1691","authenticated-orcid":false,"given":"William D","family":"Leslie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg R2H 2A6 ,","place":["Canada"]},{"name":"Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg MB R3A 1R9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"9","key":"2026033010081866400_ref1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/nrendo.2012.36","article-title":"Arterial calcification and bone physiology: role of the bone-vascular axis","volume":"8","author":"Thompson","year":"2012","journal-title":"Nat Rev 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