{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:35:34Z","timestamp":1790919334920,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Osteoporosis and associated fractures are an increasingly prevalent concern with an ageing population. This study reports testing of IBEX Bone Health (IBEX BH) software, applied following acquisition of forearm radiographs. IBEX Bone Health analyses the radiograph to measure areal bone mineral density (aBMD) at the examination site. A non-randomized cross-sectional study design was performed involving 261 (254 after exclusions) participants (112\/142\u00a0m\/f; mean age 70.8\u00a0years (SD+\/\u20139.0); 53 with osteoporosis). They underwent posterior\u2013anterior distal forearm radiographs; dual X-ray absorptiometry (DXA) of the wrists, hips, and lumbar spine; and questionnaires exploring clinical risk factors. IBEX Bone Health automatically identifies regions of interest (ROI) at the ultra-distal (UD) and distal third (TD) regions of the radius. Analysis investigated area under the receiver operating characteristics curve performance of IBEX BH for prediction of (i) osteoporosis (based on clinical reporting of the hip and spine DXA) and (ii) treatment recommendations by Fracture Risk Assessment Tool (FRAX) inclusive of neck of femur (NoF) areal bone mineral density (aBMD) results following National Osteoporosis Guideline Group (NOGG) guidelines. Area under the receiver operating characteristics curve for osteoporosis prediction at the UD and TD ROIs were 0.86 (99% confidence interval (CI) [0.80, 0.91]) and 0.81 (99% CI [0.75, 0.88]), respectively. Area under the receiver operating characteristics curve for treatment recommendation using FRAX inclusive of NoF aBMD at the UD and TD ROIs were 0.95 (99% CI [0.91, 1.00]) and 0.97 (99% CI [0.93,1.00]), respectively. With a matched sensitivity to FRAX (without NoF aBMD) 0.93 (99% CI [0.78, 0.99]), IBEX BH predicted at the UD and TD ROIs recommended treatment outcomes by NOGG guidelines using FRAX (with NoF aBMD) with specificity 0.89 (99% CI 0.83, 0.94]) and 0.93 (99% CI [0.87, 0.97]), respectively. This is compared with 0.60 (99% CI [0.51, 0.69]) for FRAX (without NoF aBMD). Results demonstrate the potential clinical utility of IBEX BH as an opportunistic screening tool.<\/jats:p>","DOI":"10.1093\/jbmrpl\/ziae020","type":"journal-article","created":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T13:19:51Z","timestamp":1710508791000},"source":"Crossref","is-referenced-by-count":9,"title":["Development of an opportunistic diagnostic prediction algorithm for osteoporosis and fragility fracture risk estimates from forearm radiographs (The OFFER1 Study)"],"prefix":"10.1093","volume":"8","author":[{"given":"Robert","family":"Meertens","sequence":"first","affiliation":[{"name":"University of Exeter , Medical Imaging Exeter, EX1 2LU , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Lopez","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Crone","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Gundry","sequence":"additional","affiliation":[{"name":"University of Exeter , Medical Imaging Exeter, EX1 2LU , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Metcalfe-Smith","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Gibbard","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jubb","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fay","family":"Manning","sequence":"additional","affiliation":[{"name":"University of Exeter , Medical Imaging Exeter, EX1 2LU , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Scott","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"McWilliam","sequence":"additional","affiliation":[{"name":"Ibex Innovations Ltd. , Sedgefield, TS21 3FD , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"issue":"1","key":"2024031513194045300_ref1","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s13018-021-02772-0","article-title":"The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis","volume":"16","author":"Salari","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"2024031513194045300_ref2","volume-title":"WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and Management of Osteoporosis : Report of a WHO Scientific Group","year":"2003"},{"issue":"1","key":"2024031513194045300_ref3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11657-021-00969-8","article-title":"Osteoporosis in Europe: a compendium of country-specific reports","volume":"17","author":"Willers","year":"2022","journal-title":"Arch Osteoporos"},{"issue":"4","key":"2024031513194045300_ref4","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00198-007-0543-5","article-title":"FRAX\u2122 and the assessment of fracture probability in men and women from the UK","volume":"19","author":"Kanis","year":"2008","journal-title":"Osteoporos Int"},{"key":"2024031513194045300_ref5","volume-title":"National Osteoporosis Guideline Group UK (NOGG). Clinical Guideline for the Prevention and Treatment of Osteoporosis","year":"2021"},{"issue":"1-2","key":"2024031513194045300_ref6","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s11657-013-0136-1","article-title":"Osteoporosis in the European Union: medical management, epidemiology and economic burden","volume":"8","author":"Hernlund","year":"2013","journal-title":"Arch Osteoporos"},{"issue":"1","key":"2024031513194045300_ref7","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11657-021-00958-x","article-title":"Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in China: a simulation projection model from 2020 to 2040","volume":"16","author":"Cui","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"3","key":"2024031513194045300_ref8","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.3390\/ijerph18031368","article-title":"The early detection of osteoporosis in a cohort of healthcare workers: is there room for a screening program?","volume":"18","author":"Rinaldi","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"2024031513194045300_ref9","doi-asserted-by":"crossref","first-page":"862.e1","DOI":"10.1016\/j.amjmed.2017.03.002","article-title":"Western osteoporosis alliance clinical practice series: evaluating the balance of benefits and risks of long-term osteoporosis therapies","volume":"130","author":"Hanley","year":"2017","journal-title":"Am J Med"},{"issue":"4","key":"2024031513194045300_ref10","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/GRF.0b013e3182a9d15a","article-title":"Osteoporosis prevention and management: nonpharmacologic and lifestyle options","volume":"56","author":"Christianson","year":"2013","journal-title":"Clin Obstet Gynecol"},{"issue":"1","key":"2024031513194045300_ref11","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11657-020-00871-9","article-title":"SCOPE 2021: a new scorecard for osteoporosis in Europe","volume":"16","author":"Kanis","year":"2021","journal-title":"Arch Osteoporos"},{"key":"2024031513194045300_ref12","first-page":"2023","volume-title":"FLS-DB Annual Report","author":"Royal College of Physicians (RCP)","year":"2023"},{"issue":"2","key":"2024031513194045300_ref13","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.bone.2004.03.024","article-title":"A meta-analysis of previous fracture and subsequent fracture risk","volume":"35","author":"Kanis","year":"2004","journal-title":"Bone"},{"key":"2024031513194045300_ref14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.bone.2016.08.011","article-title":"Diagnostic devices for osteoporosis in the general population: a systematic review","volume":"92","author":"H\u00f8iberg","year":"2016","journal-title":"Bone"},{"issue":"1-2","key":"2024031513194045300_ref15","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s11657-013-0144-1","article-title":"SCOPE: a scorecard for osteoporosis in Europe","volume":"8","author":"Kanis","year":"2013","journal-title":"Arch Osteoporos"},{"issue":"12","key":"2024031513194045300_ref16","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1089\/jwh.2012.3812","article-title":"Osteoporosis healthcare disparities in postmenopausal women","volume":"21","author":"Irene Hamrick","year":"2012","journal-title":"J Women's Health"},{"issue":"2","key":"2024031513194045300_ref17","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jocd.2012.03.002","article-title":"Reference data for bone mineral density in Swedish women using digital X-ray radiometry","volume":"16","author":"Arvidsson","year":"2013","journal-title":"J Clin Densitom"},{"issue":"7","key":"2024031513194045300_ref18","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1302\/2046-3758.77.BJR-2017-0332.R1","article-title":"Radiographic predictors for bone mineral loss","volume":"7","author":"He","year":"2018","journal-title":"Bone Joint Res"},{"issue":"12","key":"2024031513194045300_ref19","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-051021","article-title":"Prospective comparative study of quantitative X-ray (QXR) versus dual energy X-ray absorptiometry to determine the performance of QXR as a predictor of bone health for adult patients in secondary care","volume":"11","author":"Rangan","year":"2021","journal-title":"BMJ Open"},{"issue":"12","key":"2024031513194045300_ref20","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1302\/2046-3758.1012.BJR-2020-0271.R1","article-title":"Cortical bone thickness of the distal radius predicts the local bone mineral density","volume":"10","author":"Schmidutz","year":"2021","journal-title":"Bone Joint Res"},{"issue":"4","key":"2024031513194045300_ref21","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1302\/0301-620X.85B4.12843","article-title":"The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus","volume":"85-B","author":"Tingart","year":"2003","journal-title":"J Bone Joint Surg Brit"},{"key":"2024031513194045300_ref22","doi-asserted-by":"crossref","first-page":"115405","DOI":"10.1016\/j.bone.2020.115405","article-title":"Cortical thickness relative to the transverse diameter of third metacarpal bone reflects bone mineral density in patients with rheumatoid arthritis","volume":"137","author":"Yoshii","year":"2020","journal-title":"Bone"},{"key":"2024031513194045300_ref23","first-page":"e0036","article-title":"Utility of distal forearm DXA as a screening tool for primary osteoporotic fragility fractures of the distal radius: a case-control study","author":"Miyamura","year":"2020"},{"issue":"7041","key":"2024031513194045300_ref24","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ"},{"key":"2024031513194045300_ref25","volume-title":"The NHS Digital SNOMED CT Browser","author":"Digital","year":"2023"},{"key":"2024031513194045300_ref26","volume-title":"UK Patent Application","author":"Scott P, Loxley N, Ratcliffe A.","year":"2018"},{"key":"2024031513194045300_ref27","volume-title":"A Bayes Linear Approach to Making Inferences from X-rays","author":"Lopez","year":"2018"},{"issue":"3","key":"2024031513194045300_ref28","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0168-9002(03)01368-8","article-title":"GEANT4\u2014a simulation toolkit. Nuclear instruments and methods in physics research section a: accelerators, spectrometers","volume":"506","author":"Agostinelli","year":"2003","journal-title":"Detect Assoc Equip"},{"key":"2024031513194045300_ref29","doi-asserted-by":"crossref","DOI":"10.21203\/rs.3.rs-3587131\/v1","volume-title":"A Comparison Between IBEX Bone Health Applied to Digital Radiographs and Dual-Energy X-Ray Absorptiometry at the Distal-Third and Ultra-Distal Regions","author":"Lopez","year":"2023"},{"key":"2024031513194045300_ref30","first-page":"453","article-title":"XNet: a convolutional neural network (CNN) implementation for medical X-ray image segmentation suitable for small datasets. Medical imaging 2019: biomedical applications in molecular","volume":"2019","author":"Bullock","journal-title":"Struct Funct Imag: SPIE"},{"key":"2024031513194045300_ref31","volume-title":"FRAX","author":"Centre for Metabolic Bone Diseases UoS","year":"2023"},{"issue":"11","key":"2024031513194045300_ref32","doi-asserted-by":"crossref","first-page":"2763","DOI":"10.1007\/s00198-013-2413-7","article-title":"Standardising the descriptive epidemiology of osteoporosis: recommendations from the epidemiology and quality of life working group of IOF","volume":"24","author":"Kanis","year":"2013","journal-title":"Osteoporos Int"},{"key":"2024031513194045300_ref33","volume-title":"R: A Language and Environment for Statistical Computing","author":"Team"},{"issue":"3","key":"2024031513194045300_ref34","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1007\/s00198-015-3443-0","article-title":"Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate","volume":"27","author":"Nakayama","year":"2016","journal-title":"Osteoporos Int"},{"key":"2024031513194045300_ref35","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2147\/CIA.S85551","article-title":"Fracture liaison services: improving outcomes for patients with osteoporosis","volume":"Volume 12","author":"Walters","year":"2017","journal-title":"Clin Interv Aging"},{"issue":"6","key":"2024031513194045300_ref36","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/jbmr.2784","article-title":"Cost-effectiveness of osteoporosis screening strategies for men","volume":"31","author":"Nayak","year":"2016","journal-title":"J Bone Miner Res"},{"issue":"11","key":"2024031513194045300_ref37","doi-asserted-by":"crossref","first-page":"751","DOI":"10.7326\/0003-4819-155-11-201112060-00007","article-title":"Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women","volume":"155","author":"Nayak","year":"2011","journal-title":"Ann Intern Med"},{"issue":"3","key":"2024031513194045300_ref38","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1002\/jbmr.1478","article-title":"Randomized controlled trial of a primary care\u2013based screening program to identify older women with prevalent osteoporotic vertebral fractures: cohort for skeletal health in Bristol and Avon (COSHIBA)","volume":"27","author":"Clark","year":"2012","journal-title":"J Bone Miner Res"},{"issue":"11","key":"2024031513194045300_ref39","doi-asserted-by":"crossref","first-page":"832","DOI":"10.7326\/0003-4819-144-11-200606060-00009","article-title":"Meta-analysis: accuracy of quantitative ultrasound for identifying patients with osteoporosis","volume":"144","author":"Nayak","year":"2006","journal-title":"Ann Intern Med"},{"issue":"5","key":"2024031513194045300_ref40","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s00198-018-4408-x","article-title":"Pulse-echo ultrasound method for detection of post-menopausal women with osteoporotic BMD","volume":"29","author":"Karjalainen","year":"2018","journal-title":"Osteoporos Int"},{"issue":"1","key":"2024031513194045300_ref41","doi-asserted-by":"crossref","DOI":"10.1007\/s11657-021-00990-x","article-title":"New technology REMS for bone evaluation compared to DXA in adult women for the osteoporosis diagnosis: a real-life experience","volume":"16","author":"Amorim","year":"2021","journal-title":"Arch Osteoporos"},{"key":"2024031513194045300_ref42","doi-asserted-by":"crossref","first-page":"279","DOI":"10.2147\/CEOR.S163237","article-title":"Cost-effectiveness of pulse-echo ultrasonometry in osteoporosis management","volume":"10","author":"Soini","year":"2018","journal-title":"Clinicoecon Outcomes Res"},{"issue":"3","key":"2024031513194045300_ref43","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/jbmr.1468","article-title":"Relationship of age to bone microstructure independent of areal bone mineral density","volume":"27","author":"Nicks","year":"2012","journal-title":"J Bone Miner Res"},{"issue":"12","key":"2024031513194045300_ref44","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1302\/2046-3758.1012.BJR-2021-0098.R1","article-title":"Preoperative measures of bone mineral density from digital wrist radiographs","volume":"10","author":"Robertson","year":"2021","journal-title":"Bone Joint Res"}],"container-title":["JBMR Plus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article-pdf\/8\/4\/ziae020\/56985482\/ziae020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article-pdf\/8\/4\/ziae020\/56985482\/ziae020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T13:20:12Z","timestamp":1710508812000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article\/doi\/10.1093\/jbmrpl\/ziae020\/7629836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,10]]},"references-count":44,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,3,10]]}},"URL":"https:\/\/doi.org\/10.1093\/jbmrpl\/ziae020","relation":{},"ISSN":["2473-4039"],"issn-type":[{"value":"2473-4039","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4,1]]},"published":{"date-parts":[[2024,3,10]]},"article-number":"ziae020"}}