An Advanced Two-Stage Model with High Sensitivity and Generalizability for Prediction of Hip Fracture Risk Using Multiple Datasets
This work addresses the need for early and accurate hip fracture risk assessment in older adults, representing an incremental improvement over existing methods.
The paper tackled the problem of low sensitivity in existing hip fracture risk prediction tools by proposing a sequential two-stage model integrating clinical and imaging data, achieving higher sensitivity and reduced missed cases compared to T-score and FRAX.
Hip fractures are a major cause of disability, mortality, and healthcare burden in older adults, underscoring the need for early risk assessment. However, commonly used tools such as the DXA T-score and FRAX often lack sensitivity and miss individuals at high risk, particularly those without prior fractures or with osteopenia. To address this limitation, we propose a sequential two-stage model that integrates clinical and imaging information to improve prediction accuracy. Using data from the Osteoporotic Fractures in Men Study (MrOS), the Study of Osteoporotic Fractures (SOF), and the UK Biobank, Stage 1 (Screening) employs clinical, demographic, and functional variables to estimate baseline risk, while Stage 2 (Imaging) incorporates DXA-derived features for refinement. The model was rigorously validated through internal and external testing, showing consistent performance and adaptability across cohorts. Compared to T-score and FRAX, the two-stage framework achieved higher sensitivity and reduced missed cases, offering a cost-effective and personalized approach for early hip fracture risk assessment. Keywords: Hip Fracture, Two-Stage Model, Risk Prediction, Sensitivity, DXA, FRAX