{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:38:35Z","timestamp":1786642715656,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"publisher","award":["2020YFA0714002"],"award-info":[{"award-number":["2020YFA0714002"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Master\u2019s Research Innovation Project of the First Clinical College of Chongqing Medical University","award":["CYYY-SSCX202525"],"award-info":[{"award-number":["CYYY-SSCX202525"]}]},{"award":["CYYY-SSCX202525"],"award-info":[{"award-number":["CYYY-SSCX202525"]}],"id":[{"id":"https:\/\/ror.org\/017z00e58","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: This study aimed to evaluate whether artificial intelligence-derived vertebral volumetric bone mineral density (AI-vBMD) and paraspinal intermuscular adipose tissue (IMAT) ratio from routine computed tomography (CT) could identify moderate-to-severe vertebral compression fractures (VCFs) in breast cancer survivors, and whether paraspinal IMAT ratio and routinely available clinical variables improved diagnostic performance. Methods: This retrospective study included 275 women with breast cancer who underwent routine non-contrast CT and lumbar quantitative computed tomography (QCT). Hounsfield unit-derived volumetric bone mineral density (HU-vBMD) was derived using a QCT-referenced HU-to-vBMD conversion equation, whereas AI-vBMD and paraspinal IMAT ratio were extracted using automated software. Moderate-to-severe VCF was defined as Genant grade \u2265 2. Agreement with QCT-vBMD was assessed using correlation, intraclass correlation coefficient (ICC), and Bland\u2013Altman analysis. Model discrimination was evaluated using receiver operating characteristic analysis and DeLong tests. Results: Moderate-to-severe VCF was present in 75 patients (27.3%). HU-vBMD and AI-vBMD showed excellent agreement with QCT-vBMD (ICC, 0.978 and 0.987, respectively). AI-vBMD outperformed HU-vBMD for identifying VCFs (AUC, 0.738 vs. 0.714; p &lt; 0.001). IMAT ratio showed comparable standalone discrimination to AI-vBMD (AUC, 0.760 vs. 0.738; p = 0.604). Adding IMAT ratio to AI-vBMD improved discrimination (AUC, 0.786 vs. 0.738; p = 0.038). The full model incorporating clinical covariates achieved the highest AUC (0.828; 95% CI, 0.778\u20130.878). Conclusions: AI-vBMD and paraspinal IMAT ratio automatically extracted from routine CT improved the diagnostic assessment of prevalent moderate-to-severe VCFs in breast cancer survivors. This study supports an automated CT-based approach that integrates vertebral bone density and paraspinal muscle\u2013fat information for opportunistic identification of clinically relevant VCFs.<\/jats:p>","DOI":"10.3390\/jcm15166283","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:01:35Z","timestamp":1786640495000},"page":"6283","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Bone Density Alone: Opportunistic Identification of Vertebral Compression Fractures in Breast Cancer Survivors Using Artificial Intelligence-Derived Vertebral Bone Density and Paraspinal Muscle\u2013Fat Metrics"],"prefix":"10.3390","volume":"15","author":[{"given":"Chengxin","family":"Wan","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingquan","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2111-1254","authenticated-orcid":false,"given":"Jie","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, 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":"Zhiwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beibei","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, 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":[[2026,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1200\/JCO.2015.64.3809","article-title":"American Cancer Society\/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline","volume":"34","author":"Runowicz","year":"2016","journal-title":"J. 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