Opportunistic CT Screening—Machine Learning Algorithm Identifies Majority of Vertebral Compression Fractures: A Cohort Study

Vertebral compression fractures (VCF) are common in patients older than 50 years but are often undiagnosed. Zebra Medical Imaging developed a VCF detection algorithm, with machine learning, to detect VCFs from CT images of the chest and/or abdomen/pelvis. In this study, we evaluated the diagnostic performance of the algorithm in identifying VCF. We conducted a blinded validation study to estimate the operating characteristics of the algorithm in identifying VCFs using previously completed CT scans from 1200 women and men aged 50 years and older at a tertiary‐care center. Each scan was independently evaluated by two of three neuroradiologists to identify and grade VCF. Disagreements were resolved by a senior neuroradiologist. The algorithm evaluated the CT scans in a separate workstream. The VCF algorithm was not able to evaluate CT scans for 113 participants. Of the remaining 1087 study participants, 588 (54%) were women. Median age was 73 years (range 51–102 years; interquartile range 66–81). For the 1087 algorithm‐evaluated participants, the sensitivity and specificity of the VCF algorithm in diagnosing any VCF were 0.66 (95% confidence interval [CI] 0.59–0.72) and 0.90 (95% CI 0.88–0.92), respectively, and for diagnosing moderate/severe VCF were 0.78 (95% CI 0.70–0.85) and 0.87 (95% CI 0.85–0.89), respectively. Implementing this VCF algorithm within radiology systems may help to identify patients at increased fracture risk and could support the diagnosis of osteoporosis and facilitate appropriate therapy. © 2023 Amgen, Inc. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.