{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:51Z","timestamp":1787635131634,"version":"build-2736575974"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder with a high recurrence rate that significantly impairs patients\u2019 quality of life. Multiple studies have confirmed that postmenopausal women, due to endocrine disorders and other physiological characteristics, represent a high-risk population for both BPPV onset and recurrence. However, efficient recurrence prediction models are currently lacking, and traditional assessment methods have limited efficacy, making it difficult to meet the needs of individualized intervention. The aim of this study was to construct and validate machine learning models for predicting BPPV recurrence in postmenopausal women, identify key risk factors, and provide evidence for early identification of high-risk populations in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed data from BPPV patients diagnosed and successfully treated at three hospitals in Sichuan Province between January 2023 and December 2025. Patients were divided into training and validation sets at a 7:3 ratio. Features were screened using LASSO regression and the Boruta algorithm. Six machine learning models were constructed: Logistic Regression (LR), Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Multilayer Perceptron (MLP), Gradient Boosting Machine (GBM), and Meta-Ensemble method. Model predictive performance was compared, and model interpretability was assessed through SHapley Additive exPlanations (SHAP) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Through dual algorithmic screening, LASSO, and Boruta delineated four model-selected predictors for BPPV recurrence in postmenopausal women: osteoporosis, serum calcium, vitamin D, and estradiol. Among the six machine learning algorithms evaluated, the Meta-Ensemble model yielded the highest AUC point estimate of 0.857 (95% confidence interval [CI], 0.779\u20130.928), delivering a harmonized overall performance. Subsequent SHAP analysis elucidated that decreased serum levels of vitamin D, calcium, and estradiol, compounded by the presence of osteoporosis, were the most critical factors driving high recurrence risk predictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Meta-Ensemble model can effectively predict BPPV recurrence risk in postmenopausal women. The four indicators of osteoporosis, serum calcium, vitamin D, and estradiol provide objective evidence for early clinical identification of high-risk populations for recurrence, facilitating the development of individualized follow-up strategies and intervention protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1890770","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:43Z","timestamp":1787631823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of benign paroxysmal positional vertigo recurrence in postmenopausal women: a machine learning-based clinical study"],"prefix":"10.3389","volume":"17","author":[{"given":"Xueqin","family":"Mi","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Chengdu Sixth People's Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemeng","family":"Xu","sequence":"additional","affiliation":[{"name":"Sichuan Provincial Bayi Rehabilitation Center","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Chengdu Sixth People's Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingchun","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, North Sichuan Medical College Affiliated Hospital","place":["Nanchong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1056\/NEJMcp1309481","article-title":"Clinical practice. Benign paroxysmal positional vertigo","volume":"370","author":"Kim","year":"2014","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.1002\/lary.24099","article-title":"Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo","volume":"123","author":"Yamanaka","year":"2013","journal-title":"Laryngoscope"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"NP112","DOI":"10.1177\/0145561320943362","article-title":"Risk factors for the recurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis","volume":"101","author":"Li","year":"2022","journal-title":"Ear Nose Throat J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"406","DOI":"10.2519\/jospt.2015.5707","article-title":"Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study","volume":"45","author":"Liao","year":"2015","journal-title":"J Orthop Sports Phys Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1016\/j.anl.2018.05.002","article-title":"Fracture probability assessed using FRAX\u00ae in elderly women with benign paroxysmal positional vertigo","volume":"45","author":"Nakada","year":"2018","journal-title":"Auris Nasus Larynx"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1136\/jnnp.2006.100420","article-title":"Epidemiology of benign paroxysmal positional vertigo: a population based study","volume":"78","author":"von Brevern","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1812718","DOI":"10.3389\/fneur.2026.1812718","article-title":"Development and external validation of a LASSO-based parsimonious nomogram for predicting BPPV recurrence: a multi-center retrospective cohort study","volume":"17","author":"Jin","year":"2026","journal-title":"Front Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1595887","DOI":"10.3389\/fneur.2025.1595887","article-title":"Risk factors and nomogram model for recurrence of benign paroxysmal positional vertigo in postmenopausal women: a multicenter cross-sectional study","volume":"16","author":"Pan","year":"2025","journal-title":"Front Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1007\/s00415-012-6712-2","article-title":"Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo","volume":"260","author":"Jeong","year":"2013","journal-title":"J Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1080\/00016489.2017.1416168","article-title":"Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo","volume":"138","author":"Han","year":"2018","journal-title":"Acta Otolaryngol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599816689667","article-title":"Clinical practice guideline: benign paroxysmal positional vertigo (update)","volume":"156","author":"Bhattacharyya","year":"2017","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The hospital anxiety and depression scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.3760\/cma.j.cn112148-20220809-00613","article-title":"Clinical practice guidelines for hypertension in China","volume":"50","year":"2022","journal-title":"Chin J Cardiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"833","DOI":"10.3760\/cma.j.issn.0253-3758.2016.10.005","article-title":"China guidelines on prevention and treatment of dyslipidemia in adults (2016 revised edition)","volume":"44","year":"2016","journal-title":"Chin J Cardiol"},{"key":"ref17","first-page":"315","article-title":"Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)","volume":"13","year":"2021","journal-title":"Chin J Diabetes Mellit"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"947204","DOI":"10.3389\/fpubh.2022.947204","article-title":"Machine learning algorithms identifying the risk of new-onset ACS in patients with type 2 diabetes mellitus: a retrospective cohort study","volume":"10","author":"Zhong","year":"2022","journal-title":"Front Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/s42256-019-0138-9","article-title":"From local explanations to global understanding with explainable AI for trees","volume":"2","author":"Lundberg","year":"2020","journal-title":"Nat Mach Intell"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e38782","DOI":"10.1016\/j.heliyon.2024.e38782","article-title":"Circulating levels of micronutrients and the risk of benign paroxysmal positional vertigo: a mendelian randomization study","volume":"10","author":"Wang","year":"2024","journal-title":"Heliyon"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.anl.2016.06.006","article-title":"Clinical features of recurrence and osteoporotic changes in benign paroxysmal positional vertigo","volume":"44","author":"Kim","year":"2017","journal-title":"Auris Nasus Larynx"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"30","DOI":"10.5606\/tftrd.2022.5964","article-title":"Predictive values of serum estradiol, calcium, and 25-hydroxyvitamin D levels for recurrence of benign paroxysmal positional vertigo in postmenopausal women","volume":"68","author":"Zhang","year":"2022","journal-title":"Turk J Phys Med Rehabil"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e0176011","DOI":"10.1371\/journal.pone.0176011","article-title":"Biochemical markers of bone turnover in benign paroxysmal positional vertigo","volume":"12","author":"Lee","year":"2017","journal-title":"PLoS One"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat Med"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1890770\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:48Z","timestamp":1787631828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1890770\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":24,"alternative-id":["10.3389\/fneur.2026.1890770"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1890770","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"1890770"}}