You ‘aorta’ look beyond muscle and bone for falls and fracture risk: New AI algorithm identifies high risk older women

A new automated machine-learning algorithm has been developed by researchers at Edith Cowan University (ECU) to accurately assess abdominal aortic calcification (AAC), which could increase the risk of fall-related hospitalisation and clinical fractures.

Journal/conference: Journal of Bone and Mineral Research

Link to research (DOI): 10.1002/jbmr.4921

Organisation/s: Edith Cowan University, The University of Sydney

Funder: Medical Research Future Fund 2022 Cardiovascular Health Mission. Grant Number: 2024225 National Health and Medical Research Council. Grant Numbers: 254627, 303169, 572604 National Heart Foundation of Australia. Grant Number: ID 102817 National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: R01 AR041398 Raine Medical Research Foundation Royal Perth Hospital Research Foundation Western Australian Future Health Research and Innovation Fund

Media release

From: Edith Cowan University

A new automated machine-learning algorithm has been developed by researchers at Edith Cowan University (ECU). The algorithm accurately assesses abdominal aortic calcification (AAC) during routine bone density testing. AAC is a recognised measure of advanced vascular disease.

The new detection method significantly shortens the timeframe to screen for AAC. Compared with the five to six minutes it would take an experienced reader to obtain an AAC score from one image, the new algorithm takes less than a minute to predict AAC scores for hundreds of images

“We know that moderate to extensive AAC, seen in one in two of these older women, is associated with falls and fractures. Determining whether these relationships remain comparable after automation is a critical step to enhance the clinical utility of lateral spine images taken during bone density testing.”

A study headed by ECU Post Doctoral Research Fellow Dr Jack Dalla Via was recently published in the Journal of Bone and Mineral Research. It found women with moderate to extensive AAC, derived through the algorithm, had an increased risk of fall-related hospitalisation and clinical fractures, compared to those with low AAC. The study is the first of its kind, revealing that automatically assessed AAC can identify older woman at an increased risk of falls and fractures.

Dr Dalla Via said that an automated algorithm would allow AAC to be instantaneously and seamlessly assessed and reported in clinical practice whenever a lateral spine image is captured.

“Importantly, our algorithm has good levels of agreement with AAC that was manually assessed by trained experts.”

“Bone density scans involve a very low radiation dose and are routinely used for osteoporosis screening, performed most commonly in older women. Therefore, the ability of this machine-learning approach to provide novel non-muscle, non-bone information on falls and fracture risk at the time of bone density testing would be extremely valuable.”

“Beyond falls and fractures, we have shown AAC to be a strong predictor of cardiovascular events, late-life dementia and mortality. This is important in the context of opportunistic health screening for other health outcomes,” he added.

Dr Dalla Via said that the potential mechanisms underlying the observed relationship between AAC and falls, and fracture-risk are as yet unknown. However, it could relate to shared underlying mechanisms such as chronic low-grade inflammation, shared risk factors such as smoking, or impaired blood flow, which could contribute to increasing fracture risk. Vascular disease could also contribute to increased falls propensity, and subsequent fractures.

The next step is to verify the performance of the algorithm in independent cohorts, particularly in routine clinical bone densitometry services.

Senior author Associate Professor Joshua Lewis said he is now keen to see the benefits of this breakthrough research being made available more widely, “There has already been interest shown by both national and international companies keen to commercialise this product.”

This work was supported by the Heart Foundation, Western Australian Future Health Research and Innovation Fund, as well as the National Health and Medical Research Council.

The study was a result of collaboration between ECU, the University of WA, INSERM, University of Minnesota, University of Manitoba, Marcus Institute for Aging Research, and Hebrew SeniorLife Harvard Medical School.

A copy of the research as it appeared in The American Society for Bone and Mineral Research can be found here.


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