Fracture Risk Prediction in Adults Over 50 Years Old Using DXA and EHR: Comparison of Traditional and Machine Learning Models in Two Large Cohorts
Mirrored from arXiv — Machine Learning for archival readability. Support the source by reading on the original site.
Statistics > Applications
arXiv:2607.28671 (stat)
[Submitted on 25 Jul 2026]
Title:Fracture Risk Prediction in Adults Over 50 Years Old Using DXA and EHR: Comparison of Traditional and Machine Learning Models in Two Large Cohorts
Authors:Jiahe Qian, Hao Dai, Kunyu Yu, Hexin Dong, Xing He, Erik A. Imel, Jiang Bian, Yifan Peng, Yi Liu
View a PDF of the paper titled Fracture Risk Prediction in Adults Over 50 Years Old Using DXA and EHR: Comparison of Traditional and Machine Learning Models in Two Large Cohorts, by Jiahe Qian and 8 other authors
View PDF
Abstract:Accurate fracture risk prediction is important for osteoporosis management, but commonly used clinical tools may not fully use information available in electronic health records (EHRs) and dual-energy X-ray absorptiometry (DXA) reports. We developed and externally validated time-to-event fracture prediction models among adults aged 50 years or older with clinically obtained DXA reports in 2 US health care systems. The development cohort was derived from NewYork-Presbyterian/Weill Cornell Medical Center and the external validation cohort from the Indiana Network for Patient Care. Predictors included demographics, lifestyle factors, prior fracture, comorbidities, medication exposures, osteoporosis treatment history, and DXA-derived T-scores extracted from radiology reports. The outcome was time from index DXA to first incident fragility fracture identified from structured diagnosis codes. We evaluated penalized Cox regression, random survival forest, gradient-boosting survival, and XGBoost survival models using 2 prespecified predictor settings and compared discrimination with clinically reported FRAX major osteoporotic fracture probabilities. The development cohort included 11,510 adults, of whom 858 sustained incident fragility fractures; the external validation cohort included 1,932 adults, of whom 180 sustained fractures. In internal validation, the expanded Cox model achieved a mean Harrell C-index of 0.779, compared with 0.653 for FRAX. In external validation, the corresponding Cox model achieved a Harrell C-index of 0.714, compared with 0.590 for FRAX; gradient-boosting survival had the highest external discrimination (0.725). EHR- and DXA-enhanced models showed better discrimination than clinically reported FRAX scores in this DXA-tested population, but calibration assessment, prospective evaluation, and implementation workflow assessment are needed before clinical use.
| Comments: | 5 figures, 4 tables, 25 pages |
| Subjects: | Applications (stat.AP); Machine Learning (cs.LG) |
| Cite as: | arXiv:2607.28671 [stat.AP] |
| (or arXiv:2607.28671v1 [stat.AP] for this version) | |
| https://doi.org/10.48550/arXiv.2607.28671
arXiv-issued DOI via DataCite
|
Full-text links:
Access Paper:
- View PDF
- TeX Source
View a PDF of the paper titled Fracture Risk Prediction in Adults Over 50 Years Old Using DXA and EHR: Comparison of Traditional and Machine Learning Models in Two Large Cohorts, by Jiahe Qian and 8 other authors
Current browse context:
stat.AP
References & Citations
Loading...
Bookmark
Bibliographic Tools
Code, Data, Media
Demos
Related Papers
About arXivLabs
Bibliographic and Citation Tools
Bibliographic Explorer Toggle
Bibliographic Explorer (What is the Explorer?)
Connected Papers Toggle
Connected Papers (What is Connected Papers?)
Litmaps Toggle
Litmaps (What is Litmaps?)
scite.ai Toggle
scite Smart Citations (What are Smart Citations?)
Code, Data and Media Associated with this Article
alphaXiv Toggle
alphaXiv (What is alphaXiv?)
Links to Code Toggle
CatalyzeX Code Finder for Papers (What is CatalyzeX?)
DagsHub Toggle
DagsHub (What is DagsHub?)
GotitPub Toggle
Gotit.pub (What is GotitPub?)
Huggingface Toggle
Hugging Face (What is Huggingface?)
ScienceCast Toggle
ScienceCast (What is ScienceCast?)
Demos
Replicate Toggle
Replicate (What is Replicate?)
Spaces Toggle
Hugging Face Spaces (What is Spaces?)
Spaces Toggle
TXYZ.AI (What is TXYZ.AI?)
Recommenders and Search Tools
Link to Influence Flower
Influence Flower (What are Influence Flowers?)
Core recommender toggle
CORE Recommender (What is CORE?)
arXivLabs: experimental projects with community collaborators
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
More from arXiv — Machine Learning
-
LoKiFormer: Locality-aware Attention with Decoupled Knowledge Memory for Efficient Large Language Model Pretraining
Aug 14
-
Which Site, and When: A Free-Satellite-Data Test of Himalayan Glacial Lake Bursts, Landslides, and Ice Floods
Aug 14
-
MARCH: Scaling Recurrent Memory with Content-Routed State Anchors
Aug 14
-
Multi-AUV Ad-hoc network-based Target Tracking: A Value Gradient Guidance Multi-Agent Diffusion Reinforcement Learning Approach
Aug 14
Discussion (0)
Sign in to join the discussion. Free account, 30 seconds — email code or GitHub.
Sign in →No comments yet. Sign in and be the first to say something.