{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:46:24Z","timestamp":1788540384233,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Breast cancer survivors face elevated risk of treatment-related bone loss, yet routine bone health assessment remains underutilized. Opportunistic bone density extraction from routine CT may address this gap. This study validated AI-derived vertebral bone mineral density (AI-vBMD) from non-contrast thoracoabdominal CT for osteoporosis screening and assessed its diagnostic value beyond clinical variables. Methods: This retrospective study included 332 breast cancer patients; AI-vBMD was successfully extracted in 325 (98%). Quantitative CT (QCT) served as reference standard. Agreement between AI-vBMD and QCT-vBMD was assessed using Pearson correlation, Bland\u2013Altman analysis, and weighted kappa for QCT-defined osteoporosis (&lt;80 mg\/cm3). Nested logistic regression models compared a clinical model with and without AI-vBMD. Discrimination [area under the curve (AUC)], calibration, and clinical utility [decision-curve analysis (DCA)] were evaluated. Results: AI-vBMD showed strong correlation with QCT-vBMD (r = 0.98, p &lt; 0.001), minimal bias (mean difference +1.82 mg\/cm3), and excellent agreement for osteoporosis classification (weighted \u03ba = 0.90). AI-vBMD alone achieved excellent discrimination for osteoporosis (AUC = 0.986). Integrating AI-vBMD into the clinical model yielded significantly higher diagnostic performance (AUC 0.988 vs. 0.879; p &lt; 0.001) and demonstrated superior net benefit across relevant decision thresholds. Conclusions: AI-derived vertebral BMD from routine CT serves as a reliable QCT-aligned imaging biomarker for opportunistic osteoporosis assessment in breast cancer patients and adds significant incremental diagnostic value beyond clinical information alone.<\/jats:p>","DOI":"10.3390\/jcm15020512","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T11:11:21Z","timestamp":1767870681000},"page":"512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Opportunistic Osteoporosis Screening in Breast Cancer Using AI-Derived Vertebral BMD from Routine CT: Validation Against QCT and Multivariable Diagnostic Modeling"],"prefix":"10.3390","volume":"15","author":[{"given":"Jiayi","family":"Pu","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children\u2019s Hospital of Chongqing Medical University, Chongqing 400014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Yubei District Traditional Chinese Medicine Hospital, Chongqing 401120, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bishan Hospital of Chongqing Medical University, Chongqing 420760, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beibei District Traditional Chinese Medicine Hospital, Chongqing 400700, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6484-9738","authenticated-orcid":false,"given":"Fajin","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1470-2045(00)00254-0","article-title":"Epidemiology of breast cancer","volume":"2","author":"Key","year":"2001","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1001\/jama.2018.19323","article-title":"Breast cancer treatment: A review","volume":"321","author":"Waks","year":"2019","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jbo.2016.03.002","article-title":"Bone-targeted treatments in cancer: The story so far","volume":"5","author":"Coleman","year":"2016","journal-title":"J. Bone Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shapiro, C.L. (2020). Osteoporosis: A long-term and late effect of breast cancer treatments. Cancers, 12.","DOI":"10.3390\/cancers12113094"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1185\/03007995.2010.533162","article-title":"Understanding and optimizing bone health in breast cancer","volume":"26","author":"Guise","year":"2010","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1002\/jbmr.1556","article-title":"Fracture risk in women with breast cancer: A population-based study","volume":"27","author":"Melton","year":"2012","journal-title":"J. Bone Miner. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2916","DOI":"10.1200\/JCO.19.01696","article-title":"Management of Osteoporosis in Survivors of Adult Cancers with Nonmetastatic Disease: ASCO Clinical Practice Guideline","volume":"37","author":"Shapiro","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s11926-020-00892-w","article-title":"Update on imaging-based measurement of bone mineral density and quality","volume":"22","author":"Link","year":"2020","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.bone.2007.02.022","article-title":"DXA in vivo BMD methodology: An erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling","volume":"41","author":"Bolotin","year":"2007","journal-title":"Bone"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/joim.12369","article-title":"Osteoporosis: The evolution of a diagnosis","volume":"277","author":"Lorentzon","year":"2015","journal-title":"J. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"446","DOI":"10.2967\/jnumed.120.256180","article-title":"Bone mineral density: Clinical relevance and quantitative assessment","volume":"62","author":"Haseltine","year":"2021","journal-title":"J. Nucl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.ejrad.2009.04.074","article-title":"Quantitative computed tomography","volume":"71","author":"Adams","year":"2009","journal-title":"Eur. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"588","DOI":"10.7326\/0003-4819-158-8-201304160-00003","article-title":"Opportunistic screening for osteoporosis using abdominal CT scans obtained for other indications","volume":"158","author":"Pickhardt","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4980","DOI":"10.1007\/s00330-019-06018-w","article-title":"Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA","volume":"29","author":"Jacob","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1007\/s00330-020-07319-1","article-title":"Opportunistic osteoporosis screening: Contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density","volume":"31","author":"Roski","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1007\/s00330-022-09136-0","article-title":"Opportunistic screening for osteoporosis and osteopenia from CT scans of the abdomen and pelvis using machine learning","volume":"33","author":"Sebro","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Guo, M., Zhang, Y., Fu, Y., Liu, X., Peng, F., Zhang, Z., and Wang, L. (2025). A comparative study of bone density in elderly people measured with AI and QCT. Front. Artif. Intell., 8.","DOI":"10.3389\/frai.2025.1582960"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jocd.2007.12.010","article-title":"Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: The 2007 ISCD Official Positions","volume":"11","author":"Engelke","year":"2008","journal-title":"J. Clin. Densitom."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1111\/eci.12677","article-title":"Hyperuricemia protects against low bone mineral density, osteoporosis and fractures: A systematic review and meta-analysis","volume":"46","author":"Veronese","year":"2016","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11864-021-00835-2","article-title":"Cancer treatment\u2013induced bone loss (CTIBL): State of the art and proper management in breast cancer patients on endocrine therapy","volume":"22","author":"Diana","year":"2021","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s11926-018-0784-7","article-title":"Opportunistic screening for osteoporosis using computed tomography: State of the art and argument for paradigm shift","volume":"20","author":"Lenchik","year":"2018","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s11914-022-00764-5","article-title":"Opportunistic screening techniques for analysis of CT scans","volume":"21","author":"Engelke","year":"2023","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e540","DOI":"10.1016\/j.crad.2022.04.002","article-title":"Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population","volume":"77","author":"Abbouchie","year":"2022","journal-title":"Clin. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s41747-024-00483-9","article-title":"Reproducibility of CT-based opportunistic vertebral volumetric bone mineral density measurements from an automated segmentation framework","volume":"8","author":"Bodden","year":"2024","journal-title":"Eur. Radiol. Exp."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1148\/radiol.211561","article-title":"Value-added opportunistic CT screening: State of the art","volume":"303","author":"Pickhardt","year":"2022","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20230047","DOI":"10.1259\/bjr.20230047","article-title":"Automated vertebral bone mineral density measurement with phantomless internal calibration in chest LDCT scans using deep learning","volume":"96","author":"Pan","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1007\/s00330-024-11046-2","article-title":"Artificial intelligence assisted automatic screening of opportunistic osteoporosis in computed tomography images from different scanners","volume":"35","author":"Wu","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1093\/annonc\/mdr017","article-title":"Management of aromatase inhibitor\u2013associated bone loss in postmenopausal women with breast cancer: Practical guidance for prevention and treatment","volume":"22","author":"Hadji","year":"2011","journal-title":"Ann. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1210\/js.2018-00052","article-title":"Cancer treatment\u2013induced bone loss in women with breast cancer and men with prostate cancer","volume":"2","author":"Taxel","year":"2018","journal-title":"J. Endocr. Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s13058-018-1061-4","article-title":"Evaluation of osteopenia and osteoporosis in younger breast cancer survivors compared with cancer-free women: A prospective cohort study","volume":"20","author":"Ramin","year":"2018","journal-title":"Breast Cancer Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1210\/edrv.23.3.0465","article-title":"Sex steroids and the construction and conservation of the adult skeleton","volume":"23","author":"Riggs","year":"2002","journal-title":"Endocr. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/1759720X11430858","article-title":"Aging and bone loss: New insights for the clinician","volume":"4","author":"Demontiero","year":"2012","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Hsieh, E., Wang, Q., Zhang, R., Niu, X., Xia, W., Fraenkel, L., and Zhang, Y. (2018). Vertebral fractures among breast cancer survivors in China: A cross-sectional study of prevalence and health services gaps. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4014-5"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0140-6736(15)60995-3","article-title":"Adjuvant denosumab in breast cancer (ABCSG-18): A multicentre, randomised, double-blind, placebo-controlled trial","volume":"386","author":"Gnant","year":"2015","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"(2015). Early Breast Cancer Trialists\u2019 Collaborative Group (EBCTCG). Adjuvant bisphosphonate treatment in early breast cancer: Meta-analyses of individual patient data from randomised trials. Lancet, 386, 1353\u20131361.","DOI":"10.1016\/S0140-6736(15)60908-4"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2062","DOI":"10.1200\/JCO.2016.70.7257","article-title":"Use of adjuvant bisphosphonates and other bone-modifying agents in breast cancer: A Cancer Care Ontario and American Society of Clinical Oncology clinical practice guideline","volume":"35","author":"Fletcher","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e505","DOI":"10.1200\/JOP.2016.018341","article-title":"Bone density screening in postmenopausal women with early-stage breast cancer treated with aromatase inhibitors","volume":"13","author":"Stratton","year":"2017","journal-title":"J. Oncol. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jbo.2016.05.007","article-title":"Assessment of bone health in breast cancer patients starting adjuvant aromatase inhibitors: A quality improvement clinical audit","volume":"5","author":"Zekri","year":"2016","journal-title":"J. Bone Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.21037\/atm-22-4559","article-title":"The definition of spine bone mineral density (BMD)-classified osteoporosis and the much inflated prevalence of spine osteoporosis in older Chinese women when using the conventional cutpoint T-score of \u22122.5","volume":"10","year":"2022","journal-title":"Ann. Transl. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7632","DOI":"10.21037\/qims-23-513","article-title":"The role of genetic and epigenetic factors in determining the risk of spinal fragility fractures: New insights in the management of spinal osteoporosis","volume":"13","author":"Syrmos","year":"2023","journal-title":"Quant. Imaging Med. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T11:53:05Z","timestamp":1767959585000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020512"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020512","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,8]]}}}