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Fan S, Cai Y, Wei Y, Yang J, Gao J, Yang Y. Sarcopenic obesity and osteoporosis: Research progress and hot spots. Exp Gerontol 2024; 195:112544. [PMID: 39147076 DOI: 10.1016/j.exger.2024.112544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/17/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
Sarcopenic obesity (SO) and osteoporosis (OP) are associated with aging and obesity. The pathogenesis of SO is complex, including glucolipid and skeletal muscle metabolic disorders caused by inflammation, insulin resistance, and other factors. Growing evidence links muscle damage to bone loss. Muscle-lipid metabolism disorders of SO disrupt the balance between bone formation and bone resorption, increasing the risk of OP. Conversely, bones also play a role in fat and muscle metabolism. In the context of aging and obesity, the comprehensive review focuses on the effects of mechanical stimulation, mesenchymal stem cells (MSCs), chronic inflammation, myokines, and adipokines on musculoskeletal, at the same time, the impact of osteokines on muscle-lipid metabolism were also analyzed. So far, exercise combined with diet therapy is the most effective strategy for increasing musculoskeletal mass. A holistic treatment of musculoskeletal diseases is still in the preliminary exploration stage. Therefore, this article aims to improve the understanding of musculoskeletal -fat interactions in SO and OP, explores targets that can provide holistic treatment for SO combined with OP, and discusses current limitations and challenges. We hope to provide relevant ideas for developing specific therapies and improving disease prognosis in the future.
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Affiliation(s)
- Shangheng Fan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China; Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China; Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Department of Pharmacology, Zunyi Medical University, Zunyi, China
| | - Yulan Cai
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yunqin Wei
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jia Yang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jianmei Gao
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China; Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Department of Pharmacology, Zunyi Medical University, Zunyi, China.
| | - Yan Yang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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Kang SJ, Kim JOR, Kim MJ, Hur YI, Haam JH, Han K, Kim YS. Preventive machine learning models incorporating health checkup data and hair mineral analysis for low bone mass identification. Sci Rep 2024; 14:18792. [PMID: 39138235 PMCID: PMC11322645 DOI: 10.1038/s41598-024-69090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Machine learning (ML) models have been increasingly employed to predict osteoporosis. However, the incorporation of hair minerals into ML models remains unexplored. This study aimed to develop ML models for predicting low bone mass (LBM) using health checkup data and hair mineral analysis. A total of 1206 postmenopausal women and 820 men aged 50 years or older at a health promotion center were included in this study. LBM was defined as a T-score below - 1 at the lumbar, femur neck, or total hip area. The proportion of individuals with LBM was 59.4% (n = 1205). The features used in the models comprised 50 health checkup items and 22 hair minerals. The ML algorithms employed were Extreme Gradient Boosting (XGB), Random Forest (RF), Gradient Boosting (GB), and Adaptive Boosting (AdaBoost). The subjects were divided into training and test datasets with an 80:20 ratio. The area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and an F1 score were evaluated to measure the performances of the models. Through 50 repetitions, the mean (standard deviation) AUROC for LBM was 0.744 (± 0.021) for XGB, the highest among the models, followed by 0.737 (± 0.023) for AdaBoost, and 0.733 (± 0.023) for GB, and 0.732 (± 0.021) for RF. The XGB model had an accuracy of 68.7%, sensitivity of 80.7%, specificity of 51.1%, PPV of 70.9%, NPV of 64.3%, and an F1 score of 0.754. However, these performance metrics did not demonstrate notable differences among the models. The XGB model identified sulfur, sodium, mercury, copper, magnesium, arsenic, and phosphate as crucial hair mineral features. The study findings emphasize the significance of employing ML algorithms for predicting LBM. Integrating health checkup data and hair mineral analysis into these models may provide valuable insights into identifying individuals at risk of LBM.
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Affiliation(s)
- Su Jeong Kang
- Department of Family Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Republic of Korea
| | - Joung Ouk Ryan Kim
- Department of AI and Big Data, Swiss School of Management, 6500, Bellinzona, Switzerland
| | - Moon Jong Kim
- Department of Family Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Republic of Korea
| | - Yang-Im Hur
- Department of Family Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Republic of Korea
| | - Ji-Hee Haam
- Department of Family Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Republic of Korea
| | - Kunhee Han
- Department of Family Medicine, Seoul Medical Center, Seoul, 02053, Republic of Korea
| | - Young-Sang Kim
- Department of Family Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 13496, Republic of Korea.
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Miura K, Tanaka SM, Chotipanich C, Chobpenthai T, Jantarato A, Khantachawana A. Osteoporosis Prediction Using Machine-Learned Optical Bone Densitometry Data. Ann Biomed Eng 2024; 52:396-405. [PMID: 37882922 PMCID: PMC10808164 DOI: 10.1007/s10439-023-03387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
Optical bone densitometry (OBD) has been developed for the early detection of osteoporosis. In recent years, machine learning (ML) techniques have been actively implemented for the areas of medical diagnosis and screening with the goal of improving diagnostic accuracy. The purpose of this study was to verify the feasibility of using the combination of OBD and ML techniques as a screening tool for osteoporosis. Dual energy X-ray absorptiometry (DXA) and OBD measurements were performed on 203 Thai subjects. From the OBD measurements and readily available demographic data, machine learning techniques were used to predict the T-score measured by the DXA. The T-score predicted using the Ridge regressor had a correlation of r = 0.512 with respect to the reference value. The predicted T-score also showed an AUC of 0.853 for discriminating individuals with osteoporosis. The results obtained suggest that the developed model is reliable enough to be used for screening for osteoporosis.
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Affiliation(s)
- Kaname Miura
- Biological Engineering Program, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand
- Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Shigeo M Tanaka
- Institute of Science and Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Chanisa Chotipanich
- National Cyclotron and PET Center, Chulabhorn Hospital, Bangkok, 10140, Thailand
| | - Thanapon Chobpenthai
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10140, Thailand
| | - Attapon Jantarato
- National Cyclotron and PET Center, Chulabhorn Hospital, Bangkok, 10140, Thailand
| | - Anak Khantachawana
- Department of Mechanical Engineering, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand.
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Zhong S, Yin X, Li X, Feng C, Gao Z, Liao X, Yang S, He S. Artificial intelligence applications in bone fractures: A bibliometric and science mapping analysis. Digit Health 2024; 10:20552076241279238. [PMID: 39257873 PMCID: PMC11384526 DOI: 10.1177/20552076241279238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
Background Bone fractures are a common medical issue worldwide, causing a serious economic burden on society. In recent years, the application of artificial intelligence (AI) in the field of fracture has developed rapidly, especially in fracture diagnosis, where AI has shown significant capabilities comparable to those of professional orthopedic surgeons. This study aimed to review the development process and applications of AI in the field of fracture using bibliometric analysis, while analyzing the research hotspots and future trends in the field. Materials and methods Studies on AI and fracture were retrieved from the Web of Science Core Collections since 1990, a retrospective bibliometric and visualized study of the filtered data was conducted through CiteSpace and Bibliometrix R package. Results A total of 1063 publications were included in the analysis, with the annual publication rapidly growing since 2017. China had the most publications, and the United States had the most citations. Technical University of Munich, Germany, had the most publications. Doornberg JN was the most productive author. Most research in this field was published in Scientific Reports. Doi K's 2007 review in Computerized Medical Imaging and Graphics was the most influential paper. Conclusion AI application in fracture has achieved outstanding results and will continue to progress. In this study, we used a bibliometric analysis to assist researchers in understanding the basic knowledge structure, research hotspots, and future trends in this field, to further promote the development of AI applications in fracture.
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Affiliation(s)
- Sen Zhong
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaobing Yin
- Nursing Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaolan Li
- Fuzhou Medical College of Nanchang University, School of Stomatology, Fuzhou, China
| | - Chaobo Feng
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Zhiqiang Gao
- Department of Joint Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiang Liao
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Sheng Yang
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shisheng He
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Guo J, He Q, She C, Liu H, Li Y. A machine learning-based online web calculator to aid in the diagnosis of sarcopenia in the US community. Digit Health 2024; 10:20552076241283247. [PMID: 39360239 PMCID: PMC11445774 DOI: 10.1177/20552076241283247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024] Open
Abstract
Background Sarcopenia places a heavy healthcare burden on individuals and society. Recognizing sarcopenia and intervening at an early stage is critical. However, there is no simple and easy-to-use prediction tool for diagnosing sarcopenia. The aim of this study was to construct a well-performing online web calculator based on a machine learning approach to predict the risk of low lean body mass (LBM) to assist in the diagnosis of sarcopenia. Methods Data from the National Health and Nutritional Examination Surveys 1999-2004 were selected for model construction, and the included data were randomly divided into training and validation sets in the ratio of 75:25. Six machine learning methods- Classification and Regression Trees, Logistic Regression, Neural Network, Random Forest, Support Vector Machine, and Extreme Gradient Boosting (XGBoost)-were used to develop the model. They are screened for features and evaluated for performance. The best-performing models were further developed as an online web calculator for clinical applications. Results There were 3046 participants enrolled in the study and 815 (26.8%) participants with LBM. Through feature screening, height, waist circumference, race, and age were used as machine learning features to construct the model. After performance evaluation and sensitivity analysis, the XGBoost-based model was determined to be the best model with better discriminative performance, clinical utility, and robustness. Conclusion The XGBoost-based model in this study has excellent performance, and the online web calculator based on it can easily and quickly predict the risk of LBM to aid in the diagnosis of sarcopenia in adults over the age of 60.
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Affiliation(s)
- Jiale Guo
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Qionghan He
- Department of Infectious Disease, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Chunjie She
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Hefeng Liu
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yehai Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
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Wu X, Zhai F, Chang A, Wei J, Guo Y, Zhang J. Application of machine learning algorithms to predict osteoporosis in postmenopausal women with type 2 diabetes mellitus. J Endocrinol Invest 2023; 46:2535-2546. [PMID: 37171784 DOI: 10.1007/s40618-023-02109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The screening and diagnosis of osteoporosis in patients with type 2 diabetes mellitus (T2DM) based on bone mineral density remains challenging because of the limited availability and accessibility of dual-energy X-ray absorptiometry. We aimed to develop and validate models to predict the risk of osteoporosis in postmenopausal women with T2DM based on machine learning (ML) algorithms. METHODS This retrospective study included 303 postmenopausal women with T2DM. To develop prediction models for osteoporosis, we applied nine ML algorithms combined with demographic, clinical, and laboratory data. The least absolute shrinkage and selection operator were used to perform feature selection. We used the bootstrap resampling technique for model training and validation. To test the performance of the models, we calculated indices including the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1 score, calibration curve, and decision curve analysis. Furthermore, we conducted fivefold cross-validation for parameter optimization and model validation. Feature importance was assessed using the SHapley additive explanation (SHAP). RESULTS We identified 10 independent predictors as the most valuable features. An AUROC of 0.616-1.000 was observed for nine ML algorithms. The extreme gradient boosting (XGBoost) model exhibited the best performance, outperforming conventional risk assessment tools and registering 0.993 in the training set, 0.798 in the validation set, and 0.786 in the test set for fivefold cross-validation. Using SHAP, we found that the explanatory variables contributed to the model and their relationship with osteoporosis occurrence. Furthermore, we developed a user-friendly tool for calculating the risk of osteoporosis. CONCLUSIONS With the integration of demographic and clinical risk factors, ML algorithms can accurately predict osteoporosis. The XGBoost model showed ideal performance. With the incorporation of these models in the clinic, patients may benefit from early osteoporosis diagnosis and treatment.
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Affiliation(s)
- X Wu
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China.
| | - F Zhai
- Gynecological Clinic, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China
| | - A Chang
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China
| | - J Wei
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China
| | - Y Guo
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China
| | - J Zhang
- Department of Endocrinology, Cangzhou Central Hospital, 16 Xinhua West Road, Cangzhou, 061000, Hebei, People's Republic of China
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Khanna VV, Chadaga K, Sampathila N, Chadaga R, Prabhu S, K S S, Jagdale AS, Bhat D. A decision support system for osteoporosis risk prediction using machine learning and explainable artificial intelligence. Heliyon 2023; 9:e22456. [PMID: 38144333 PMCID: PMC10746430 DOI: 10.1016/j.heliyon.2023.e22456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Osteoporosis is a metabolic bone condition that occurs when bone mineral density and mass decrease. This makes the bones weak and brittle. The disorder is often undiagnosed and untreated due to its asymptomatic nature until the manifestation of a fracture. Machine Learning (ML) is extensively used in diverse healthcare domains to analyze precise outcomes, provide timely risk scores, and allocate resources. Hence, we have designed multiple heterogeneous machine-learning frameworks to predict the risk of Osteoporosis. An open-source dataset of 1493 patients containing bone density, blood, and physical tests is utilized. Thirteen distinct feature selection techniques were leveraged to extract the most salient parameters. The best-performing pipeline consisted of a Forward Feature Selection algorithm followed by a custom multi-level ensemble learning-based stack, which achieved an accuracy of 89 %. Deploying a layer of explainable artificial intelligence using tools such as SHAP (SHapley Additive Values), LIME (Local Interpretable Model Explainer), ELI5, Qlattice, and feature importance provided interpretability and rationale behind classifier prediction. With this study, we aim to provide the holistic risk prediction of Osteoporosis and concurrently present a system for automated screening to assist physicians in making diagnostic decisions.
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Affiliation(s)
- Varada Vivek Khanna
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
| | - Krishnaraj Chadaga
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
| | - Niranjana Sampathila
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
| | - Rajagopala Chadaga
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
| | - Srikanth Prabhu
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
| | - Swathi K S
- Department of Social And Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Aditya S. Jagdale
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Devadas Bhat
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, India
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Ong W, Liu RW, Makmur A, Low XZ, Sng WJ, Tan JH, Kumar N, Hallinan JTPD. Artificial Intelligence Applications for Osteoporosis Classification Using Computed Tomography. Bioengineering (Basel) 2023; 10:1364. [PMID: 38135954 PMCID: PMC10741220 DOI: 10.3390/bioengineering10121364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoporosis, marked by low bone mineral density (BMD) and a high fracture risk, is a major health issue. Recent progress in medical imaging, especially CT scans, offers new ways of diagnosing and assessing osteoporosis. This review examines the use of AI analysis of CT scans to stratify BMD and diagnose osteoporosis. By summarizing the relevant studies, we aimed to assess the effectiveness, constraints, and potential impact of AI-based osteoporosis classification (severity) via CT. A systematic search of electronic databases (PubMed, MEDLINE, Web of Science, ClinicalTrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 39 articles were retrieved from the databases, and the key findings were compiled and summarized, including the regions analyzed, the type of CT imaging, and their efficacy in predicting BMD compared with conventional DXA studies. Important considerations and limitations are also discussed. The overall reported accuracy, sensitivity, and specificity of AI in classifying osteoporosis using CT images ranged from 61.8% to 99.4%, 41.0% to 100.0%, and 31.0% to 100.0% respectively, with areas under the curve (AUCs) ranging from 0.582 to 0.994. While additional research is necessary to validate the clinical efficacy and reproducibility of these AI tools before incorporating them into routine clinical practice, these studies demonstrate the promising potential of using CT to opportunistically predict and classify osteoporosis without the need for DEXA.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Ren Wei Liu
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Weizhong Jonathan Sng
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore (A.M.); (X.Z.L.); (W.J.S.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Yang Q, Cheng H, Qin J, Loke AY, Ngai FW, Chong KC, Zhang D, Gao Y, Wang HH, Liu Z, Hao C, Xie YJ. A Machine Learning-Based Preclinical Osteoporosis Screening Tool (POST): Model Development and Validation Study. JMIR Aging 2023; 6:e46791. [PMID: 37986117 PMCID: PMC10686208 DOI: 10.2196/46791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023] Open
Abstract
Background Identifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. Objective We aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning-based method among the Hong Kong Chinese population. Methods Participants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning-based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t score of -2.5 or lower. We constructed machine learning models, including gradient boosting machines, support vector machines, and naive Bayes, as well as the commonly used logistic regression models, for the prediction of osteoporosis. The best-performing model was chosen as the final tool, named the Preclinical Osteoporosis Screening Tool (POST). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and other metrics. Results Among the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6% (n=85). The machine learning-based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1-score were 0.41, 0.98, and 0.56, respectively. Conclusions The machine learning-based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making.
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Affiliation(s)
- Qingling Yang
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Huilin Cheng
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Qin
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Alice Yuen Loke
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Fei Wan Ngai
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ka Chun Chong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dexing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Zhaomin Liu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Yao Jie Xie
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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10
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Tzou SJ, Peng CH, Huang LY, Chen FY, Kuo CH, Wu CZ, Chu TW. Comparison between linear regression and four different machine learning methods in selecting risk factors for osteoporosis in a Chinese female aged cohort. J Chin Med Assoc 2023; 86:1028-1036. [PMID: 37729604 DOI: 10.1097/jcma.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Population aging is emerging as an increasingly acute challenge for countries around the world. One particular manifestation of this phenomenon is the impact of osteoporosis on individuals and national health systems. Previous studies of risk factors for osteoporosis were conducted using traditional statistical methods, but more recent efforts have turned to machine learning approaches. Most such efforts, however, treat the target variable (bone mineral density [BMD] or fracture rate) as a categorical one, which provides no quantitative information. The present study uses five different machine learning methods to analyze the risk factors for T-score of BMD, seeking to (1) compare the prediction accuracy between different machine learning methods and traditional multiple linear regression (MLR) and (2) rank the importance of 25 different risk factors. METHODS The study sample includes 24 412 women older than 55 years with 25 related variables, applying traditional MLR and five different machine learning methods: classification and regression tree, Naïve Bayes, random forest, stochastic gradient boosting, and eXtreme gradient boosting. The metrics used for model performance comparisons are the symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error. RESULTS Machine learning approaches outperformed MLR for all four prediction errors. The average importance ranking of each factor generated by the machine learning methods indicates that age is the most important factor determining T-score, followed by estimated glomerular filtration rate (eGFR), body mass index (BMI), uric acid (UA), and education level. CONCLUSION In a group of women older than 55 years, we demonstrated that machine learning methods provide superior performance in estimating T-Score, with age being the most important impact factor, followed by eGFR, BMI, UA, and education level.
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Affiliation(s)
- Shiow-Jyu Tzou
- Teaching and Researching Center, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC
| | - Chung-Hsin Peng
- Department of Urology, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Li-Ying Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Fang-Yu Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Chun-Heng Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Chung-Ze Wu
- Department of Internal Medicine, Shuang Ho Hospital, New Taipei City, Division of Endocrinology and Metabolism, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ta-Wei Chu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- MJ Health Research Foundation, Taipei, Taiwan, ROC
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11
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Xie CL, Yue YT, Xu JP, Li N, Lin T, Ji GR, Yang XW, Xu R. Penicopeptide A (PPA) from the deep-sea-derived fungus promotes osteoblast-mediated bone formation and alleviates ovariectomy-induced bone loss by activating the AKT/GSK-3β/β-catenin signaling pathway. Pharmacol Res 2023; 197:106968. [PMID: 37866705 DOI: 10.1016/j.phrs.2023.106968] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
The potential of marine natural products as effective drugs for osteoporosis treatment is an understudied area. In this study, we investigated the ability of lead compounds from deep-sea-derived Penicillium solitum MCCC 3A00215 to promote bone formation in vitro and in vivo. We found that penicopeptide A (PPA) promoted osteoblast mineralization among bone marrow mesenchymal stem cells (BMSCs) in a concentration-dependent manner, and thus, we selected this natural peptide for further testing. Our further experiments showed that PPA significantly promoted the osteogenic differentiation of BMSCs while inhibiting their adipogenic differentiation and not affecting their chondrogenic differentiation. Mechanistic studies showed that PPA binds directly to the AKT and GSK-3β and activates phosphorylation of AKT and GSK-3β, resulting in the accumulation of β-catenin. We also evaluated the therapeutic potential of PPA in a female mouse model of ovariectomy-induced systemic bone loss. In this model, PPA treatment prevented decreases in bone volume and trabecular thickness. In conclusion, our in vitro and in vivo results demonstrated that PPA could promote osteoblast-related bone formation via the AKT, GSK-3β, and β-catenin signaling pathways, indicating the clinical potential of PPA as a candidate compound for osteoporosis prevention.
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Affiliation(s)
- Chun-Lan Xie
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen 361102, China; Key Laboratory of Marine Genetic Resources, Third Institute of Oceanography, Ministry of Natural Resources, Xiamen 361005, China
| | - Yu-Ting Yue
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen 361102, China; Department of Orthopedics Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361102, Xiamen,China
| | - Jing-Ping Xu
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Na Li
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Ting Lin
- Fujian Provincial Key Laboratory of Innovative Drug Target Research, School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China
| | - Guang-Rong Ji
- Department of Orthopedics Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361102, Xiamen,China.
| | - Xian-Wen Yang
- Key Laboratory of Marine Genetic Resources, Third Institute of Oceanography, Ministry of Natural Resources, Xiamen 361005, China.
| | - Ren Xu
- Fujian Provincial Key Laboratory of Organ and Tissue Regeneration, School of Medicine, Xiamen University, Xiamen 361102, China; The First Affiliated Hospital of Xiamen University-ICMRS Collaborating Center for Skeletal Stem Cells, State Key Laboratory of Cellular Stress Biology, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen 361102, China.
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Wingood M, Criss MG, Irwin KE, Freshman C, Phillips EL, Dhaliwal P, Chui KK. Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review. J Geriatr Phys Ther 2023; 46:E137-E147. [PMID: 36827688 DOI: 10.1519/jpt.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties. METHODS A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP. RESULTS +LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability. CONCLUSION Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.
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Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington
| | - Michelle G Criss
- School of Health Sciences, Chatham University, Pittsburgh, Pennsylvania
| | - Kent E Irwin
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois
| | - Christina Freshman
- Department of Physical Therapy, Lebanon Valley College, Annville, Pennsylvania
| | | | - Puneet Dhaliwal
- Department of Physical Therapy, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Kevin K Chui
- Department of Physical Therapy, Radford University, Roanoke, Virginia
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Zhang J, Xu Z, Fu Y, Chen L. Prediction of the Risk of Bone Mineral Density Decrease in Type 2 Diabetes Mellitus Patients Based on Traditional Multivariate Logistic Regression and Machine Learning: A Preliminary Study. Diabetes Metab Syndr Obes 2023; 16:2885-2898. [PMID: 37744700 PMCID: PMC10517691 DOI: 10.2147/dmso.s422515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose There remains a lack of a machine learning (ML) model incorporating body composition to assess the risk of bone mineral density (BMD) decreases in type 2 diabetes mellitus (T2DM) patients. We aimed to use ML algorithms and the traditional multivariate logistic regression to establish prediction models for BMD decreases in T2DM patients over 50 years of age, and compare the performance of the two methods. Patients and Methods This cross-sectional study was conducted among 450 patients with T2DM from 1 August 2016 to 31 December 2022. The participants were divided into a normal BMD group and a decreased BMD group. Traditional multivariate logistic regression and six ML algorithms were selected to construct male and female models. Two nomograms were constructed to evaluate the risk of BMD decreases in the male and female T2DM patients, respectively. The ML models with the highest area under the curve (AUC) were compared with the traditional multivariate logistic regression models in terms of discriminant ability and clinical applicability. Results The optimal ML model was the extreme gradient boost (XGBoost) model. The AUCs of the traditional multivariate logistic regression and the XGBoost models were 0.722 and 0.800 in the male testing dataset, respectively, and 0.876 and 0.880 in the female testing dataset, respectively. The decision curve analysis results suggested that using the XGBoost models to predict the risk of BMD decreases obtained more net benefits compared with the traditional models in both sexes. Conclusion We preliminarily proved that the XGBoost models outperformed most other ML models in both sexes and achieved higher accuracy than traditional analyses. Due to the limited sample size in the study, it is necessary to validate our findings in larger prospective cohort studies.
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Affiliation(s)
- Junli Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China
| | - Zhenghui Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China
| | - Yu Fu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China
| | - Lu Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China
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14
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Han D, Fan Z, Chen YS, Xue Z, Yang Z, Liu D, Zhou R, Yuan H. Retrospective study: risk assessment model for osteoporosis-a detailed exploration involving 4,552 Shanghai dwellers. PeerJ 2023; 11:e16017. [PMID: 37701834 PMCID: PMC10494836 DOI: 10.7717/peerj.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Background Osteoporosis, a prevalent orthopedic issue, significantly influences patients' quality of life and results in considerable financial burden. The objective of this study was to develop and validate a clinical prediction model for osteoporosis risk, utilizing computer algorithms and demographic data. Method In this research, a total of 4,552 residents from Shanghai were retrospectively included. LASSO regression analysis was executed on the sample's basic characteristics, and logistic regression was employed for analyzing clinical characteristics and building a predictive model. The model's diagnostic capacity for predicting osteoporosis risk was assessed using R software and computer algorithms. Results The predictive nomogram model for bone loss risk, derived from the LASSO analysis, comprised factors including BMI, TC, TG, HDL, Gender, Age, Education, Income, Sleep, Alcohol Consumption, and Diabetes. The nomogram prediction model demonstrated impressive discriminative capability, with a C-index of 0.908 (training set), 0.908 (validation set), and 0.910 (entire cohort). The area under the ROC curve (AUC) of the model was 0.909 (training set), 0.903 (validation set), and applicable to the entire cohort. The decision curve analysis further corroborated that the model could efficiently predict the risk of bone loss in patients. Conclusion The nomogram, based on essential demographic and health factors (Body Mass Index, Total Cholesterol, Triglycerides, High-Density Lipoprotein, Gender, Age, Education, Income, Sleep, Alcohol Consumption, and Diabetes), offered accurate predictions for the risk of bone loss within the studied population.
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Affiliation(s)
- Dan Han
- Department of Emergency Medicine and Intensive Care, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Shanghai, Shanghai, China
| | - Zhongcheng Fan
- Department of Orthopaedics, Hainan Province Clinical Medical Center, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People’s Hospital, Haikou, China
| | - Yi-sheng Chen
- Department of Sports medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zichao Xue
- Department of Orthopaedics, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Zhenwei Yang
- Department of Orthopaedics, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Danping Liu
- Department of Orthopaedics, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Rong Zhou
- Department Two of Medical Administration, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Yuan
- Department Two of Medical Administration, Zhongshan Hospital, Fudan University, Shanghai, China
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15
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Wu X, Zhai F, Chang A, Wei J, Guo Y, Zhang J. Development of Machine Learning Models for Predicting Osteoporosis in Patients with Type 2 Diabetes Mellitus-A Preliminary Study. Diabetes Metab Syndr Obes 2023; 16:1987-2003. [PMID: 37408729 PMCID: PMC10319347 DOI: 10.2147/dmso.s406695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Diagnosing osteoporosis in T2DM based on bone mineral density (BMD) remains challenging. We sought to develop prediction models employing machine learning algorithms for use as screening instruments for osteoporosis in T2DM patients. Patients and Methods Data were collected from 433 participants and analyzed using nine categorical machine learning algorithms to select features based on demographic and clinical variables. Multiple classification models were compared using the area under the receiver operating characteristic curve (ROC-AUC), accuracy, sensitivity, specificity, the average precision (AP), precision, F1 score, precision-recall curves, calibration plots, and decision curve analysis (DCA) to determine the best model. In addition, 5-fold cross-validation was utilized to optimize the model, followed by an evaluation of feature significance using Shapley Additive exPlanations (SHAP). Using latent class analysis (LCA), distinct subpopulations were identified by constructing several discrete clusters. Results In this study, nine feature variables were identified to construct predictive models for osteoporosis in individuals with T2DM. The machine learning algorithms achieved an AP range of 0.444-1.000. The XGBoost model was selected as the final prediction model with an AUROC of 0.940 in the training set, 0.772 in the validation set for 5-fold cross-validation, and 0.872 in the test set. Using SHAP methodology, 25(OH)D was identified as the most important risk factor. Additionally, a 3-Class model was constructed using LCA, which categorized individuals into high, medium, and low-risk groups. Conclusion Our study developed a predictive model with high accuracy and clinical validity for predicting osteoporosis in type 2 diabetes patients. We also identified three subpopulations with varying osteoporosis risk using clustering. However, limited sample size warrants cautious interpretation of results, and validation in larger cohorts is needed.
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Affiliation(s)
- Xuelun Wu
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
| | - Furui Zhai
- Gynecological Clinic, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
| | - Ailing Chang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
| | - Jing Wei
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
| | - Yanan Guo
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
| | - Jincheng Zhang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou City, Hebei Province, People’s Republic of China
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Zeitlin J, Parides MK, Lane JM, Russell LA, Kunze KN. A clinical prediction model for 10-year risk of self-reported osteoporosis diagnosis in pre- and perimenopausal women. Arch Osteoporos 2023; 18:78. [PMID: 37273115 DOI: 10.1007/s11657-023-01292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
A machine learning model using clinical, laboratory, and imaging data was developed to predict 10-year risk of menopause-related osteoporosis. The resulting predictions, which are sensitive and specific, highlight distinct clinical risk profiles that can be used to identify patients most likely to be diagnosed with osteoporosis. PURPOSE The aim of this study was to incorporate demographic, metabolic, and imaging risk factors into a model for long-term prediction of self-reported osteoporosis diagnosis. METHODS This was a secondary analysis of 1685 patients from the longitudinal Study of Women's Health Across the Nation using data collected between 1996 and 2008. Participants were pre- or perimenopausal women between 42 and 52 years of age. A machine learning model was trained using 14 baseline risk factors-age, height, weight, body mass index, waist circumference, race, menopausal status, maternal osteoporosis history, maternal spine fracture history, serum estradiol level, serum dehydroepiandrosterone level, serum thyroid-stimulating hormone level, total spine bone mineral density, and total hip bone mineral density. The self-reported outcome was whether a doctor or other provider had told participants they have osteoporosis or treated them for osteoporosis. RESULTS At 10-year follow-up, a clinical osteoporosis diagnosis was reported by 113 (6.7%) women. Area under the receiver operating characteristic curve of the model was 0.83 (95% confidence interval, 0.73-0.91) and Brier score was 0.054 (95% confidence interval, 0.035-0.074). Total spine bone mineral density, total hip bone mineral density, and age had the largest contributions to predicted risk. Using two discrimination thresholds, stratification into low, medium, and high risk, respectively, was associated with likelihood ratios of 0.23, 3.2, and 6.8. At the lower threshold, sensitivity was 0.81, and specificity was 0.82. CONCLUSION The model developed in this analysis integrates clinical data, serum biomarker levels, and bone mineral densities to predict 10-year risk of osteoporosis with good performance.
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Affiliation(s)
- Jacob Zeitlin
- Weill Cornell Medical College, New York, NY, USA.
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| | - Michael K Parides
- Department of Biostatistics and Bioinformatics, Hospital for Special Surgery, New York, NY, USA
| | - Joseph M Lane
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Metabolic Bone Health Center, Hospital for Special Surgery, New York, NY, USA
| | - Linda A Russell
- Metabolic Bone Health Center, Hospital for Special Surgery, New York, NY, USA
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Mao Y, Lan H, Lin W, Liang J, Huang H, Li L, Wen J, Chen G. Machine learning algorithms are comparable to conventional regression models in predicting distant metastasis of follicular thyroid carcinoma. Clin Endocrinol (Oxf) 2023; 98:98-109. [PMID: 35171531 DOI: 10.1111/cen.14693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Distant metastasis often indicates a poor prognosis, so early screening and diagnosis play a significant role. Our study aims to construct and verify a predictive model based on machine learning (ML) algorithms that can estimate the risk of distant metastasis of newly diagnosed follicular thyroid carcinoma (FTC). DESIGN This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. PATIENTS A total of 5809 FTC patients were included in the data analysis. Among them, there were 214 (3.68%) cases with distant metastasis. METHOD Univariate and multivariate logistic regression (LR) analyses were used to determine independent risk factors. Seven commonly used ML algorithms were applied for predictive model construction. We used the area under the receiver-operating characteristic (AUROC) curve to select the best ML algorithm. The optimal model was trained through 10-fold cross-validation and visualized by SHapley Additive exPlanations (SHAP). Finally, we compared it with the traditional LR method. RESULTS In terms of predicting distant metastasis, the AUROCs of the seven ML algorithms were 0.746-0.836 in the test set. Among them, the Extreme Gradient Boosting (XGBoost) had the best prediction performance, with an AUROC of 0.836 (95% confidence interval [CI]: 0.775-0.897). After 10-fold cross-validation, its predictive power could reach the best [AUROC: 0.855 (95% CI: 0.803-0.906)], which was slightly higher than the classic binary LR model [AUROC: 0.845 (95% CI: 0.818-0.873)]. CONCLUSIONS The XGBoost approach was comparable to the conventional LR method for predicting the risk of distant metastasis for FTC.
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Affiliation(s)
- Yaqian Mao
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Huiyu Lan
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jixing Liang
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Huibin Huang
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Liantao Li
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Junping Wen
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Gang Chen
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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Mao Y, Zhu Z, Pan S, Lin W, Liang J, Huang H, Li L, Wen J, Chen G. Value of machine learning algorithms for predicting diabetes risk: A subset analysis from a real-world retrospective cohort study. J Diabetes Investig 2022; 14:309-320. [PMID: 36345236 PMCID: PMC9889616 DOI: 10.1111/jdi.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 10/04/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS/INTRODUCTION To compare the application value of different machine learning (ML) algorithms for diabetes risk prediction. MATERIALS AND METHODS This is a 3-year retrospective cohort study with a total of 3,687 participants being included in the data analysis. Modeling variable screening and predictive model building were carried out using logistic regression (LR) analysis and 10-fold cross-validation, respectively. In total, six different ML algorithms, including random forests, light gradient boosting machine, extreme gradient boosting, adaptive boosting (AdaBoost), multi-layer perceptrons and gaussian naive bayes were used for model construction. Model performance was mainly evaluated by the area under the receiver operating characteristic curve. The best performing ML model was selected for comparison with the traditional LR model and visualized using Shapley additive explanations. RESULTS A total of eight risk factors most associated with the development of diabetes were identified by univariate and multivariate LR analysis, and they were visualized in the form of a nomogram. Among the six different ML models, the random forests model had the best predictive performance. After 10-fold cross-validation, its optimal model has an area under the receiver operating characteristic value of 0.855 (95% confidence interval [CI] 0.823-0.886) in the training set and 0.835 (95% CI 0.779-0.892) in the test set. In the traditional LR model, its area under the receiver operating characteristic value is 0.840 (95% CI 0.814-0.866) in the training set and 0.834 (95% CI 0.785-0.884) in the test set. CONCLUSIONS In the real-world epidemiological research, the combination of traditional variable screening and ML algorithm to construct a diabetes risk prediction model has satisfactory clinical application value.
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Affiliation(s)
- Yaqian Mao
- Department of Internal Medicine, Fujian Provincial Hospital South BranchShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Zheng Zhu
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Shuyao Pan
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Wei Lin
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Jixing Liang
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Huibin Huang
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Liantao Li
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Junping Wen
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Gang Chen
- Department of Endocrinology, Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouChina,Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of MedicalFuzhouChina
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Decision Tree Modeling for Osteoporosis Screening in Postmenopausal Thai Women. INFORMATICS 2022. [DOI: 10.3390/informatics9040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Osteoporosis is still a serious public health issue in Thailand, particularly in postmenopausal women; meanwhile, new effective screening tools are required for rapid diagnosis. This study constructs and confirms an osteoporosis screening tool-based decision tree (DT) model. Four DT algorithms, namely, classification and regression tree; chi-squared automatic interaction detection (CHAID); quick, unbiased, efficient statistical tree; and C4.5, were implemented on 356 patients, of whom 266 were abnormal and 90 normal. The investigation revealed that the DT algorithms have insignificantly different performances regarding the accuracy, sensitivity, specificity, and area under the curve. Each algorithm possesses its characteristic performance. The optimal model is selected according to the performance of blind data testing and compared with traditional screening tools: Osteoporosis Self-Assessment for Asians and the Khon Kaen Osteoporosis Study. The Decision Tree for Postmenopausal Osteoporosis Screening (DTPOS) tool was developed from the best performance of CHAID’s algorithms. The age of 58 years and weight at a cutoff of 57.8 kg were the essential predictors of our tool. DTPOS provides a sensitivity of 92.3% and a positive predictive value of 82.8%, which might be used to rule in subjects at risk of osteopenia and osteoporosis in a community-based screening as it is simple to conduct.
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Ren G, Yu K, Xie Z, Wang P, Zhang W, Huang Y, Wang Y, Wu X. Current Applications of Machine Learning in Spine: From Clinical View. Global Spine J 2022; 12:1827-1840. [PMID: 34628966 PMCID: PMC9609532 DOI: 10.1177/21925682211035363] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES This review aims to present current applications of machine learning (ML) in spine domain to clinicians. METHODS We conducted a comprehensive PubMed search of peer-reviewed articles that were published between 2006 and 2020 using terms (spine, spinal, lumbar, cervical, thoracic, machine learning) to examine ML in spine. Then exclude research of other domain, case report, review or meta-analysis, and which without available abstract or full text. RESULTS Total 1738 articles were retrieved from database, and 292 studies were finally included. Key findings of current applications were compiled and summarized in this review. Main clinical applications of those techniques including image processing, diagnosis, decision supporting, operative assistance, rehabilitation, surgery outcomes, complications, hospitalization and cost. CONCLUSIONS ML had achieved excellent performance and hold immense potential in spine. ML could help clinical staff to improve medical level, enhance work efficiency, and reduce adverse events. However more randomized controlled trials and improvement of interpretability are essential to clinicians accepting models' assistance in real work.
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Affiliation(s)
- GuanRui Ren
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Kun Yu
- Nanjing Jiangbei Hospital, Nanjing,
Jiangsu, China
| | - ZhiYang Xie
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - PeiYang Wang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Wei Zhang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - Yong Huang
- Southeast University Medical College,
Nanjing, Jiangsu, China
| | - YunTao Wang
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China,YunTao Wang, Department of Spine Surgery,
Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao
Road, Nanjing, Jiangsu 210009, China.
| | - XiaoTao Wu
- Department of Spine Surgery, Zhongda
Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China,XiaoTao Wu, Department of Spine Surgery,
Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao
Road, Nanjing, Jiangsu 210009, China.
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Mao Y, Huang Y, Xu L, Liang J, Lin W, Huang H, Li L, Wen J, Chen G. Surgical Methods and Social Factors Are Associated With Long-Term Survival in Follicular Thyroid Carcinoma: Construction and Validation of a Prognostic Model Based on Machine Learning Algorithms. Front Oncol 2022; 12:816427. [PMID: 35800057 PMCID: PMC9253987 DOI: 10.3389/fonc.2022.816427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to establish and verify an effective machine learning (ML) model to predict the prognosis of follicular thyroid cancer (FTC), and compare it with the eighth edition of the American Joint Committee on Cancer (AJCC) model.MethodsKaplan-Meier method and Cox regression model were used to analyze the risk factors of cancer-specific survival (CSS). Propensity-score matching (PSM) was used to adjust the confounding factors of different surgeries. Nine different ML algorithms,including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Random Forests (RF), Logistic Regression (LR), Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GaussianNB), K-Nearest Neighbor (KNN), Support Vector Machine (SVM) and Multi-Layer Perceptron (MLP),were used to build prognostic models of FTC.10-fold cross-validation and SHapley Additive exPlanations were used to train and visualize the optimal ML model.The AJCC model was built by multivariate Cox regression and visualized through nomogram. The performance of the XGBoost model and AJCC model was mainly assessed using the area under the receiver operating characteristic (AUROC).ResultsMultivariate Cox regression showed that age, surgical methods, marital status, T classification, N classification and M classification were independent risk factors of CSS. Among different surgeries, the prognosis of one-sided thyroid lobectomy plus isthmectomy (LO plus IO) was the best, followed by total thyroidectomy (hazard ratios: One-sided thyroid LO plus IO, 0.086[95% confidence interval (CI),0.025-0.290], P<0.001; total thyroidectomy (TT), 0.490[95%CI,0.295-0.814], P=0.006). PSM analysis proved that one-sided thyroid LO plus IO, TT, and partial thyroidectomy had no significant differences in long-term prognosis. Our study also revealed that married patients had better prognosis than single, widowed and separated patients (hazard ratios: single, 1.686[95%CI,1.146-2.479], P=0.008; widowed, 1.671[95%CI,1.163-2.402], P=0.006; separated, 4.306[95%CI,2.039-9.093], P<0.001). Among different ML algorithms, the XGBoost model had the best performance, followed by Gaussian NB, RF, LR, MLP, LightGBM, AdaBoost, KNN and SVM. In predicting FTC prognosis, the predictive performance of the XGBoost model was relatively better than the AJCC model (AUROC: 0.886 vs. 0.814).ConclusionFor high-risk groups, effective surgical methods and well marital status can improve the prognosis of FTC. Compared with the traditional AJCC model, the XGBoost model has relatively better prediction accuracy and clinical usage.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yanling Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lizhen Xu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jixing Liang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huibin Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Liantao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, China
- *Correspondence: Gang Chen,
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Kwon Y, Lee J, Park JH, Kim YM, Kim SH, Won YJ, Kim HY. Osteoporosis Pre-Screening Using Ensemble Machine Learning in Postmenopausal Korean Women. Healthcare (Basel) 2022; 10:healthcare10061107. [PMID: 35742158 PMCID: PMC9222287 DOI: 10.3390/healthcare10061107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
As osteoporosis is a degenerative disease related to postmenopausal aging, early diagnosis is vital. This study used data from the Korea National Health and Nutrition Examination Surveys to predict a patient’s risk of osteoporosis using machine learning algorithms. Data from 1431 postmenopausal women aged 40–69 years were used, including 20 features affecting osteoporosis, chosen by feature importance and recursive feature elimination. Random Forest (RF), AdaBoost, and Gradient Boosting (GBM) machine learning algorithms were each used to train three models: A, checkup features; B, survey features; and C, both checkup and survey features, respectively. Of the three models, Model C generated the best outcomes with an accuracy of 0.832 for RF, 0.849 for AdaBoost, and 0.829 for GBM. Its area under the receiver operating characteristic curve (AUROC) was 0.919 for RF, 0.921 for AdaBoost, and 0.908 for GBM. By utilizing multiple feature selection methods, the ensemble models of this study achieved excellent results with an AUROC score of 0.921 with AdaBoost, which is 0.1–0.2 higher than those of the best performing models from recent studies. Our model can be further improved as a practical medical tool for the early diagnosis of osteoporosis after menopause.
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Affiliation(s)
| | - Juyeon Lee
- AIDX, Inc., Yongin-si 16954, Korea; (J.L.); (J.H.P.)
| | - Joo Hee Park
- AIDX, Inc., Yongin-si 16954, Korea; (J.L.); (J.H.P.)
| | - Yoo Mee Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea; (Y.M.K.); (S.H.K.)
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea; (Y.M.K.); (S.H.K.)
| | - Young Jun Won
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Korea; (Y.M.K.); (S.H.K.)
- Correspondence: (Y.J.W.); (H.-Y.K.)
| | - Hyung-Yong Kim
- AIDX, Inc., Yongin-si 16954, Korea; (J.L.); (J.H.P.)
- Correspondence: (Y.J.W.); (H.-Y.K.)
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23
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Quah Y, Yi-Le JC, Park NH, Lee YY, Lee EB, Jang SH, Kim MJ, Rhee MH, Lee SJ, Park SC. Serum biomarker-based osteoporosis risk prediction and the systemic effects of Trifolium pratense ethanolic extract in a postmenopausal model. Chin Med 2022; 17:70. [PMID: 35701790 PMCID: PMC9199188 DOI: 10.1186/s13020-022-00622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent years, a soaring number of marketed Trifolium pratense (red clover) extract products have denoted that a rising number of consumers are turning to natural alternatives to manage postmenopausal symptoms. T. pratense ethanolic extract (TPEE) showed immense potential for their uses in the treatment of menopause complications including osteoporosis and hormone dependent diseases. Early diagnosis of osteoporosis can increase the chance of efficient treatment and reduce fracture risks. Currently, the most common diagnosis of osteoporosis is performed by using dual-energy x-ray absorptiometry (DXA). However, the major limitation of DXA is that it is inaccessible and expensive in rural areas to be used for primary care inspection. Hence, serum biomarkers can serve as a meaningful and accessible data for osteoporosis diagnosis. Methods The present study systematically elucidated the anti-osteoporosis and estrogenic activities of TPEE in ovariectomized (OVX) rats by evaluating the bone microstructure, uterus index, serum and bone biomarkers, and osteoblastic and osteoclastic gene expression. Leverage on a pool of serum biomarkers obtained from this study, recursive feature elimination with a cross-validation method (RFECV) was used to select useful biomarkers for osteoporosis prediction. Then, using the key features extracted, we employed five classification algorithms: extreme gradient boosting (XGBoost), random forest, support vector machine, artificial neural network, and decision tree to predict the bone quality in terms of T-score. Results TPEE treatments down-regulated nuclear factor kappa-B ligand, alkaline phosphatase, and up-regulated estrogen receptor β gene expression. Additionally, reduced serum C-terminal telopeptides of type 1 collagen level and improvement in the estrogen dependent characteristics of the uterus on the lining of the lumen were observed in the TPEE intervention group. Among the tested classifiers, XGBoost stood out as the best performing classification model with the highest F1-score and lowest standard deviation. Conclusions The present study demonstrates that TPEE treatment showed therapeutic benefits in the prevention of osteoporosis at the transcriptional level and maintained the estrogen dependent characteristics of the uterus. Our study revealed that, in the case of limited number of features, RFECV paired with XGBoost model could serve as a powerful tool to readily evaluate and diagnose postmenopausal osteoporosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13020-022-00622-7.
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Affiliation(s)
- Yixian Quah
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea.,Reproductive and Development Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Jireh Chan Yi-Le
- Centre of IoT and Big Data, Universiti Tunku Abdul Rahman, 31900, Kampar, Perak, Malaysia
| | - Na-Hye Park
- Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Yuan Yee Lee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Eon-Bee Lee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Seung-Hee Jang
- Teazen Co. Ltd., Gyegok-myeon, Haenam-gun, Jeollanam-do, 59017, Republic of Korea
| | - Min-Jeong Kim
- Teazen Co. Ltd., Gyegok-myeon, Haenam-gun, Jeollanam-do, 59017, Republic of Korea
| | - Man Hee Rhee
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea
| | - Seung-Jin Lee
- Reproductive and Development Toxicology Research Group, Korea Institute of Toxicology, Daejeon, Republic of Korea.
| | - Seung-Chun Park
- College of Veterinary Medicine and Cardiovascular Research Institute, Kyungpook National University, 80 Daehak-ro, Daegu, 41566, Republic of Korea.
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Liu L, Si M, Ma H, Cong M, Xu Q, Sun Q, Wu W, Wang C, Fagan MJ, Mur LAJ, Yang Q, Ji B. A hierarchical opportunistic screening model for osteoporosis using machine learning applied to clinical data and CT images. BMC Bioinformatics 2022; 23:63. [PMID: 35144529 PMCID: PMC8829991 DOI: 10.1186/s12859-022-04596-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/02/2022] [Indexed: 01/10/2023] Open
Abstract
Background Osteoporosis is a common metabolic skeletal disease and usually lacks obvious symptoms. Many individuals are not diagnosed until osteoporotic fractures occur. Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for osteoporosis detection. However, only a limited percentage of people with osteoporosis risks undergo the DXA test. As a result, it is vital to develop methods to identify individuals at-risk based on methods other than DXA. Results We proposed a hierarchical model with three layers to detect osteoporosis using clinical data (including demographic characteristics and routine laboratory tests data) and CT images covering lumbar vertebral bodies rather than DXA data via machine learning. 2210 individuals over age 40 were collected retrospectively, among which 246 individuals’ clinical data and CT images are both available. Irrelevant and redundant features were removed via statistical analysis. Consequently, 28 features, including 16 clinical data and 12 texture features demonstrated statistically significant differences (p < 0.05) between osteoporosis and normal groups. Six machine learning algorithms including logistic regression (LR), support vector machine with radial-basis function kernel, artificial neural network, random forests, eXtreme Gradient Boosting and Stacking that combined the above five classifiers were employed as classifiers to assess the performances of the model. Furthermore, to diminish the influence of data partitioning, the dataset was randomly split into training and test set with stratified sampling repeated five times. The results demonstrated that the hierarchical model based on LR showed better performances with an area under the receiver operating characteristic curve of 0.818, 0.838, and 0.962 for three layers, respectively in distinguishing individuals with osteoporosis and normal BMD. Conclusions The proposed model showed great potential in opportunistic screening for osteoporosis without additional expense. It is hoped that this model could serve to detect osteoporosis as early as possible and thereby prevent serious complications of osteoporosis, such as osteoporosis fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s12859-022-04596-z.
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Affiliation(s)
- Liyu Liu
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China
| | - Meng Si
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Hecheng Ma
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Menglin Cong
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Quanzheng Xu
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China
| | - Qinghua Sun
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China
| | - Weiming Wu
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China
| | - Cong Wang
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China
| | - Michael J Fagan
- School of Engineering, University of Hull, Hull, HU6 7RX, UK
| | - Luis A J Mur
- Institute of Biological, Environmental and Rural Sciences (IBERS), Aberystwyth University, Aberystwyth, Wales, UK
| | - Qing Yang
- Department of Breast and Thyroid, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Bing Ji
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, Shandong, People's Republic of China.
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Park HW, Jung H, Back KY, Choi HJ, Ryu KS, Cha HS, Lee EK, Hong AR, Hwangbo Y. Application of Machine Learning to Identify Clinically Meaningful Risk Group for Osteoporosis in Individuals Under the Recommended Age for Dual-Energy X-Ray Absorptiometry. Calcif Tissue Int 2021; 109:645-655. [PMID: 34195852 DOI: 10.1007/s00223-021-00880-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis; it is generally recommended in men ≥ 70 and women ≥ 65 years old. Therefore, assessment of clinical risk factors for osteoporosis is very important in individuals under the recommended age for DXA. Here, we examine the diagnostic performance of machine learning-based prediction models for osteoporosis in individuals under the recommended age for DXA examination. Data of 2210 men aged 50-69 and 1099 women aged 50-64 obtained from the Korea National Health and Nutrition Examination Survey IV-V were analyzed. Extreme gradient boosting (XGBoost) was used to find relevant clinical features and applied to three machine learning models: XGBoost, logistic regression, and a multilayer perceptron. For the prediction of osteoporosis, the XGBoost model using the top 20 features extracted from XGBoost showed the most reliable performance with area under the receiver operating characteristic curve (AUROC) of 0.73 and 0.79 in men and women, respectively. We compared the diagnostic accuracy of the Shapley additive explanation values based on a risk-score model obtained from XGBoost and conventional osteoporosis risk assessment tools for prediction of osteoporosis using optimal cut-off values for each model. We observed that a cut-off risk score of ≥ 28 in men and ≥ 47 in women was optimal to classify a positive screening for osteoporosis (an AUROC of 0.86 in men and 0.91 in women). The XGBoost-based osteoporosis-prediction model outperformed conventional risk assessment tools. Therefore, machine learning-based prediction models are a more suitable option than conventional risk assessment methods for screening osteoporosis in individuals under the recommended age for DXA examination.
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Affiliation(s)
- Hyun Woo Park
- Healthcare AI Team, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - Hyojung Jung
- Healthcare AI Team, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - Kyoung Yeon Back
- Healthcare AI Team, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - Hyeon Ju Choi
- Healthcare AI Team, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - Kwang Sun Ryu
- Cancer Big Data Center, National Cancer Center, National Cancer Control Institute, Goyang, South Korea
| | - Hyo Soung Cha
- Cancer Big Data Center, National Cancer Center, National Cancer Control Institute, Goyang, South Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, South Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, 61469, South Korea.
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.
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Yamamoto N, Sukegawa S, Yamashita K, Manabe M, Nakano K, Takabatake K, Kawai H, Ozaki T, Kawasaki K, Nagatsuka H, Furuki Y, Yorifuji T. Effect of Patient Clinical Variables in Osteoporosis Classification Using Hip X-rays in Deep Learning Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57080846. [PMID: 34441052 PMCID: PMC8398956 DOI: 10.3390/medicina57080846] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
Background and Objectives: A few deep learning studies have reported that combining image features with patient variables enhanced identification accuracy compared with image-only models. However, previous studies have not statistically reported the additional effect of patient variables on the image-only models. This study aimed to statistically evaluate the osteoporosis identification ability of deep learning by combining hip radiographs with patient variables. Materials andMethods: We collected a dataset containing 1699 images from patients who underwent skeletal-bone-mineral density measurements and hip radiography at a general hospital from 2014 to 2021. Osteoporosis was assessed from hip radiographs using convolutional neural network (CNN) models (ResNet18, 34, 50, 101, and 152). We also investigated ensemble models with patient clinical variables added to each CNN. Accuracy, precision, recall, specificity, F1 score, and area under the curve (AUC) were calculated as performance metrics. Furthermore, we statistically compared the accuracy of the image-only model with that of an ensemble model that included images plus patient factors, including effect size for each performance metric. Results: All metrics were improved in the ResNet34 ensemble model compared with the image-only model. The AUC score in the ensemble model was significantly improved compared with the image-only model (difference 0.004; 95% CI 0.002–0.0007; p = 0.0004, effect size: 0.871). Conclusions: This study revealed the additional effect of patient variables in identification of osteoporosis using deep CNNs with hip radiographs. Our results provided evidence that the patient variables had additive synergistic effects on the image in osteoporosis identification.
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Affiliation(s)
- Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (N.Y.); (T.Y.)
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka 530-000, Japan
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
- Correspondence: ; Tel.: +81-878-113-333
| | - Kazutaka Yamashita
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
| | - Masaki Manabe
- Department of Radiation Technology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan;
| | - Keisuke Kawasaki
- Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan; (K.Y.); (K.K.)
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan;
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (N.Y.); (T.Y.)
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Abstract
Falls are one of the most common accidents among inpatients and may result in extended hospitalization and increased medical costs. Constructing a highly accurate fall prediction model could effectively reduce the rate of patient falls, further reducing unnecessary medical costs and patient injury. This study applied data mining techniques on a hospital's electronic medical records database comprising a nursing information system to construct inpatient-fall-prediction models for use during various stages of inpatient care. The inpatient data were collected from 15 inpatient wards. To develop timely and effective fall prediction models for inpatients, we retrieved the data of multiple-time assessment variables at four points during hospitalization. This study used various supervised machine learning algorithms to build classification models. Four supervised learning and two classifier ensemble techniques were selected for model development. The results indicated that Bagging+RF classifiers yielded optimal prediction performance at all four points during hospitalization. This study suggests that nursing personnel should be aware of patients' risk factors based on comprehensive fall risk assessment and provide patients with individualized fall prevention interventions to reduce inpatient fall rates.
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Affiliation(s)
- Chia-Hui Liu
- Author Affiliations: Department of Nursing (Ms Liu), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi; Department of Information Management and Institute of Healthcare Information Management (Ms Liu and Dr Lin), Center for Innovative Research on Aging Society (Dr Lin), National Chung Cheng University, Chiayi; National Central University, Taoyuan City (Dr Hu); MOST AI Biomedical Research Center, National Cheng Kung University, Tainan (Dr Hu), Taiwan, Republic of China
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Yamamoto N, Sukegawa S, Kitamura A, Goto R, Noda T, Nakano K, Takabatake K, Kawai H, Nagatsuka H, Kawasaki K, Furuki Y, Ozaki T. Deep Learning for Osteoporosis Classification Using Hip Radiographs and Patient Clinical Covariates. Biomolecules 2020; 10:biom10111534. [PMID: 33182778 PMCID: PMC7697189 DOI: 10.3390/biom10111534] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 01/10/2023] Open
Abstract
This study considers the use of deep learning to diagnose osteoporosis from hip radiographs, and whether adding clinical data improves diagnostic performance over the image mode alone. For objective labeling, we collected a dataset containing 1131 images from patients who underwent both skeletal bone mineral density measurement and hip radiography at a single general hospital between 2014 and 2019. Osteoporosis was assessed from the hip radiographs using five convolutional neural network (CNN) models. We also investigated ensemble models with clinical covariates added to each CNN. The accuracy, precision, recall, specificity, negative predictive value (npv), F1 score, and area under the curve (AUC) score were calculated for each network. In the evaluation of the five CNN models using only hip radiographs, GoogleNet and EfficientNet b3 exhibited the best accuracy, precision, and specificity. Among the five ensemble models, EfficientNet b3 exhibited the best accuracy, recall, npv, F1 score, and AUC score when patient variables were included. The CNN models diagnosed osteoporosis from hip radiographs with high accuracy, and their performance improved further with the addition of clinical covariates from patient records.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan; (N.Y.); (K.K.)
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan;
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
- Correspondence: ; Tel.: +81-87-811-3333; Fax: +81-87-835-8363
| | - Akira Kitamura
- Search Space Inc., Tokyo 151-0072, Japan; (A.K.); (R.G.)
| | - Ryosuke Goto
- Search Space Inc., Tokyo 151-0072, Japan; (A.K.); (R.G.)
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan; (K.N.); (K.T.); (H.K.); (H.N.)
| | - Keisuke Kawasaki
- Department of Orthopaedic Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan; (N.Y.); (K.K.)
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1, Asahi-machi, Takamatsu, Kagawa 760-8557, Japan;
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
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Zhang B, Yu K, Ning Z, Wang K, Dong Y, Liu X, Liu S, Wang J, Zhu C, Yu Q, Duan Y, Lv S, Zhang X, Chen Y, Wang X, Shen J, Peng J, Chen Q, Zhang Y, Zhang X, Zhang S. Deep learning of lumbar spine X-ray for osteopenia and osteoporosis screening: A multicenter retrospective cohort study. Bone 2020; 140:115561. [PMID: 32730939 DOI: 10.1016/j.bone.2020.115561] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022]
Abstract
Osteoporosis is a prevalent but underdiagnosed condition. As compared to dual-energy X-ray absorptiometry (DXA) measures, we aimed to develop a deep convolutional neural network (DCNN) model to classify osteopenia and osteoporosis with the use of lumbar spine X-ray images. Herein, we developed the DCNN models based on the training dataset, which comprising 1616 lumbar spine X-ray images from 808 postmenopausal women (aged 50 to 92 years). DXA-derived bone mineral density (BMD) measures were used as the reference standard. We categorized patients into three groups according to DXA BMD T-score: normal (T ≥ -1.0), osteopenia (-2.5 < T < -1.0), and osteoporosis (T ≤ -2.5). T-scores were calculated by using the BMD dataset of young Chinese female aged 20-40 years as a reference. A 3-class DCNN model was trained to classify normal BMD, osteoporosis, and osteopenia. Model performance was tested in a validation dataset (204 images from 102 patients) and two test datasets (396 images from 198 patients and 348 images from 147 patients respectively). Model performance was assessed by the receiver operating characteristic (ROC) curve analysis. The results showed that in the test dataset 1, the model diagnosing osteoporosis achieved an AUC of 0.767 (95% confidence interval [CI]: 0.701-0.824) with sensitivity of 73.7% (95% CI: 62.3-83.1), the model diagnosing osteopenia achieved an AUC of 0.787 (95% CI: 0.723-0.842) with sensitivity of 81.8% (95% CI: 67.3-91.8); In the test dataset 2, the model diagnosing osteoporosis yielded an AUC of 0.726 (95% CI: 0.646-0.796) with sensitivity of 68.4% (95% CI: 54.8-80.1), the model diagnosing osteopenia yielded an AUC of 0.810 (95% CI, 0.737-0.870) with sensitivity of 85.3% (95% CI, 68.9-95.0). Accordingly, a deep learning diagnostic network may have the potential in screening osteoporosis and osteopenia based on lumbar spine radiographs. However, further studies are necessary to verify and improve the diagnostic performance of DCNN models.
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Affiliation(s)
- Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China; Jinan University, Guangzhou, Guangdong, PR China
| | - Keyan Yu
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Zhenyuan Ning
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Ke Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yuhao Dong
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | - Xian Liu
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, PR China
| | - Shuxue Liu
- The Affiliated Zhongshan Hospital of Traditional Chinese Medicine University of Guangzhou, Guangdong, PR China
| | - Jian Wang
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Cuiling Zhu
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Qinqin Yu
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Yuwen Duan
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Siying Lv
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Xintao Zhang
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Yanjun Chen
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Xiaojia Wang
- Bone mineral density test room, Health Management Centre, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Jie Shen
- Department of endocrinology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China
| | - Jia Peng
- Department of computed tomography, The Affiliated Zhongshan City Hospital of Sun Yat-sen University, PR China
| | - Qiuying Chen
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China; Jinan University, Guangzhou, Guangdong, PR China
| | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, PR China.
| | - Xiaodong Zhang
- Department of Medical Imaging, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics Guangdong Province), Guangzhou, PR China.
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China.
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Shim JG, Kim DW, Ryu KH, Cho EA, Ahn JH, Kim JI, Lee SH. Application of machine learning approaches for osteoporosis risk prediction in postmenopausal women. Arch Osteoporos 2020; 15:169. [PMID: 33097976 DOI: 10.1007/s11657-020-00802-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/29/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Many predictive tools have been reported for assessing osteoporosis risk. The development and validation of osteoporosis risk prediction models were supported by machine learning. INTRODUCTION Osteoporosis is a silent disease until it results in fragility fractures. However, early diagnosis of osteoporosis provides an opportunity to detect and prevent fractures. We aimed to develop machine learning approaches to achieve high predictive ability for osteoporosis risk that could help primary care providers identify which women are at increased risk of osteoporosis and should therefore undergo further testing with bone densitometry. METHODS We included all postmenopausal Korean women from the Korea National Health and Nutrition Examination Surveys (KNHANES V-1, V-2) conducted in 2010 and 2011. Machine learning models using methods such as the k-nearest neighbors (KNN), decision tree (DT), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), artificial neural networks (ANN), and logistic regression (LR) were developed to predict osteoporosis risk. We analyzed the effect of applying the machine learning algorithms to the raw data and featuring the selected data only where the statistically significant variables were included as model inputs. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate performance among the seven models. RESULTS A total of 1792 patients were included in this study, of which 613 had osteoporosis. The raw data consisted of 19 variables and achieved performances (in terms of AUROCs) of 0.712, 0.684, 0.727, 0.652, 0.724, 0.741, and 0.726 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. The feature selected data consisted of nine variables and achieved performances (in terms of AUROCs) of 0.713, 0.685, 0.734, 0.728, 0.728, 0.743, and 0.727 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. CONCLUSION In this study, we developed and compared seven machine learning models to accurately predict osteoporosis risk. The ANN model performed best when compared to the other models, having the highest AUROC value. Applying the ANN model in the clinical environment could help primary care providers stratify osteoporosis patients and improve the prevention, detection, and early treatment of osteoporosis.
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Affiliation(s)
- Jae-Geum Shim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Dong Woo Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Kyoung-Ho Ryu
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Jin-Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Jeong-In Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea
| | - Sung Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemoonan-ro, Gonro-gu, Seoul, 03181, Republic of Korea.
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Diagnostic and Gradation Model of Osteoporosis Based on Improved Deep U-Net Network. J Med Syst 2019; 44:15. [PMID: 31811448 DOI: 10.1007/s10916-019-1502-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
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Zhang M, Gong H, Zhang K, Zhang M. Prediction of lumbar vertebral strength of elderly men based on quantitative computed tomography images using machine learning. Osteoporos Int 2019; 30:2271-2282. [PMID: 31401661 DOI: 10.1007/s00198-019-05117-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 07/30/2019] [Indexed: 02/07/2023]
Abstract
UNLABELLED The parameters extracted from quantitative computed tomography (QCT) images were used to predict vertebral strength through machine learning models, and the highly accurate prediction indicated that it may be a promising approach to assess fracture risk in clinics. INTRODUCTION Vertebral fracture is common in elderly populations. The main factor contributing to vertebral fracture is the reduced vertebral strength. This study aimed to predict vertebral strength based on clinical QCT images by using machine learning. METHODS Eighty subjects with QCT data of lumbar spine were randomly selected from the MrOS cohorts. L1 vertebral strengths were computed by QCT-based finite element analysis. A total of 58 features of each L1 vertebral body were extracted from QCT images, including grayscale distribution, grayscale values of 39 partitioned regions, BMDQCT, structural rigidity, axial rigidity, and BMDQCTAmin. Feature selection and dimensionality reduction were used to simplify the 58 features. General regression neural network and support vector regression models were developed to predict vertebral strength. Performance of prediction models was quantified by the mean squared error, the coefficient of determination, the mean bias, and the SD of bias. RESULTS The 58 parameters were simplified to five features (grayscale value of the 60% percentile, grayscale values of three specific partitioned regions, and BMDQCTAmin) and nine principal components (PCs). High accuracy was achieved by using the five features or the nine PCs to predict vertebral strength. CONCLUSIONS This study provided an effective approach to predict vertebral strength and showed that it may have great potential in clinical applications for noninvasive assessment of vertebral fracture risk.
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Affiliation(s)
- M Zhang
- Department of Engineering Mechanics, Jilin University, Nanling Campus, Changchun, 130025, People's Republic of China
| | - H Gong
- Department of Engineering Mechanics, Jilin University, Nanling Campus, Changchun, 130025, People's Republic of China.
| | - K Zhang
- Department of Engineering Mechanics, Jilin University, Nanling Campus, Changchun, 130025, People's Republic of China
| | - M Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Hum, Kowloon, Hong Kong SAR, People's Republic of China
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Liu Y, Munteanu CR, Yan Q, Pedreira N, Kang J, Tang S, Zhou C, He Z, Tan Z. Machine learning classification models for fetal skeletal development performance prediction using maternal bone metabolic proteins in goats. PeerJ 2019; 7:e7840. [PMID: 31649832 PMCID: PMC6802673 DOI: 10.7717/peerj.7840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background In developing countries, maternal undernutrition is the major intrauterine environmental factor contributing to fetal development and adverse pregnancy outcomes. Maternal nutrition restriction (MNR) in gestation has proven to impact overall growth, bone development, and proliferation and metabolism of mesenchymal stem cells in offspring. However, the efficient method for elucidation of fetal bone development performance through maternal bone metabolic biochemical markers remains elusive. Methods We adapted goats to elucidate fetal bone development state with maternal serum bone metabolic proteins under malnutrition conditions in mid- and late-gestation stages. We used the experimental data to create 72 datasets by mixing different input features such as one-hot encoding of experimental conditions, metabolic original data, experimental-centered features and experimental condition probabilities. Seven Machine Learning methods have been used to predict six fetal bone parameters (weight, length, and diameter of femur/humerus). Results The results indicated that MNR influences fetal bone development (femur and humerus) and fetal bone metabolic protein levels (C-terminal telopeptides of collagen I, CTx, in middle-gestation and N-terminal telopeptides of collagen I, NTx, in late-gestation), and maternal bone metabolites (low bone alkaline phosphatase, BALP, in middle-gestation and high BALP in late-gestation). The results show the importance of experimental conditions (ECs) encoding by mixing the information with the serum metabolic data. The best classification models obtained for femur weight (Fw) and length (FI), and humerus weight (Hw) are Support Vector Machines classifiers with the leave-one-out cross-validation accuracy of 1. The rest of the accuracies are 0.98, 0.946 and 0.696 for the diameter of femur (Fd), diameter and length of humerus (Hd, Hl), respectively. With the feature importance analysis, the moving averages mixed ECs are generally more important for the majority of the models. The moving average of parathyroid hormone (PTH) within nutritional conditions (MA-PTH-experim) is important for Fd, Hd and Hl prediction models but its removal for enhancing the Fw, Fl and Hw model performance. Further, using one feature models, it is possible to obtain even more accurate models compared with the feature importance analysis models. In conclusion, the machine learning is an efficient method to confirm the important role of PTH and BALP mixed with nutritional conditions for fetal bone growth performance of goats. All the Python scripts including results and comments are available into an open repository at https://gitlab.com/muntisa/goat-bones-machine-learning.
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Affiliation(s)
- Yong Liu
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Cristian R Munteanu
- RNASA-IMEDIR, Computer Science Faculty, University of A Coruna, A Coruña, Spain.,Biomedical Research Institute of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), A Coruña, Spain
| | - Qiongxian Yan
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Nieves Pedreira
- RNASA-IMEDIR, Computer Science Faculty, University of A Coruna, A Coruña, Spain
| | - Jinhe Kang
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Shaoxun Tang
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Chuanshe Zhou
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Zhixiong He
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
| | - Zhiliang Tan
- CAS Key Laboratory for Agro-Ecological Processes in Subtropical Region, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha, Hunan, China
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Meng J, Sun N, Chen Y, Li Z, Cui X, Fan J, Cao H, Zheng W, Jin Q, Jiang L, Zhu W. Artificial neural network optimizes self-examination of osteoporosis risk in women. J Int Med Res 2019; 47:3088-3098. [PMID: 31179797 PMCID: PMC6683875 DOI: 10.1177/0300060519850648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective This study aimed to investigate the application of an artificial neural network (ANN) in optimizing the Osteoporosis Self-Assessment Tool for Asians (OSTA) score. Methods OSTA score was calculated for each female participant that underwent dual-energy X-ray absorptiometry examination in two hospitals (one in each of two Chinese cities, Harbin and Ningbo). An ANN model was built using age and weight as input and femoral neck T-score as output. Osteoporosis risk screening by joint application of ANN and OSTA score was evaluated by receiver operating characteristic curve analysis. Results Nearly 90% of women with dual-energy X-ray absorptiometry-determined femoral neck osteoporosis were ≥60 years old. The ANN with age and weight as input and OSTA score both identified osteoporosis, with respective accuracy rates of 78.8% and 78.3%. However, both methods failed to identify osteoporosis in women < 60 years old. Compared with OSTA score alone, combined use of the two tools increased the rate of osteoporosis recognition among women > 80 years old. Conclusions OSTA score-mediated osteoporosis risk screening should be restricted to women ≥60 years old. Joint application of ANN and OSTA improved osteoporosis risk screening among Chinese women > 80 years old.
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Affiliation(s)
- Jia Meng
- 1 Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ning Sun
- 2 Office of Academic Research, Ningbo Health Career Technical College, Ningbo, China
| | - Yali Chen
- 3 Department of Spine Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | | | - Xiaomeng Cui
- 5 School of Measurement-Control Tech & Communications Engineering, Harbin University of Science and Technology, Harbin, China
| | - Jingxue Fan
- 1 Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hailing Cao
- 1 Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wangping Zheng
- 3 Department of Spine Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Qiying Jin
- 3 Department of Spine Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Lihong Jiang
- 1 Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenliang Zhu
- 6 Department of Pharmacy, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Cabitza F, Locoro A, Banfi G. Machine Learning in Orthopedics: A Literature Review. Front Bioeng Biotechnol 2018; 6:75. [PMID: 29998104 PMCID: PMC6030383 DOI: 10.3389/fbioe.2018.00075] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022] Open
Abstract
In this paper we present the findings of a systematic literature review covering the articles published in the last two decades in which the authors described the application of a machine learning technique and method to an orthopedic problem or purpose. By searching both in the Scopus and Medline databases, we retrieved, screened and analyzed the content of 70 journal articles, and coded these resources following an iterative method within a Grounded Theory approach. We report the survey findings by outlining the articles' content in terms of the main machine learning techniques mentioned therein, the orthopedic application domains, the source data and the quality of their predictive performance.
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Affiliation(s)
- Federico Cabitza
- Dipartimento di Informatica, Sistemistica e Comunicazione, Universitá degli Studi di Milano-Bicocca, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Giuseppe Banfi
- Dipartimento di Informatica, Sistemistica e Comunicazione, Universitá degli Studi di Milano-Bicocca, Milan, Italy
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Abstract
In our previous study, our input data set consisted of 78 rats, the blood loss in percent as a dependent variable, and 11 independent variables (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, respiration rate, temperature, perfusion index, lactate concentration, shock index, and new index (lactate concentration/perfusion)). The machine learning methods for multicategory classification were applied to a rat model in acute hemorrhage to predict the four Advanced Trauma Life Support (ATLS) hypovolemic shock classes for triage in our previous study. However, multicategory classification is much more difficult and complicated than binary classification. We introduce a simple approach for classifying ATLS hypovolaemic shock class by predicting blood loss in percent using support vector regression and multivariate linear regression (MLR). We also compared the performance of the classification models using absolute and relative vital signs. The accuracies of support vector regression and MLR models with relative values by predicting blood loss in percent were 88.5% and 84.6%, respectively. These were better than the best accuracy of 80.8% of the direct multicategory classification using the support vector machine one-versus-one model in our previous study for the same validation data set. Moreover, the simple MLR models with both absolute and relative values could provide possibility of the future clinical decision support system for ATLS classification. The perfusion index and new index were more appropriate with relative changes than absolute values.
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Cruz AS, Lins HC, Medeiros RVA, Filho JMF, da Silva SG. Artificial intelligence on the identification of risk groups for osteoporosis, a general review. Biomed Eng Online 2018; 17:12. [PMID: 29378578 PMCID: PMC5789692 DOI: 10.1186/s12938-018-0436-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The goal of this paper is to present a critical review on the main systems that use artificial intelligence to identify groups at risk for osteoporosis or fractures. The systems considered for this study were those that fulfilled the following requirements: range of coverage in diagnosis, low cost and capability to identify more significant somatic factors. METHODS A bibliographic research was done in the databases, PubMed, IEEExplorer Latin American and Caribbean Center on Health Sciences Information (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, and Science Direct searching the terms "Neural Network", "Osteoporosis Machine Learning" and "Osteoporosis Neural Network". Studies with titles not directly related to the research topic and older data that reported repeated strategies were excluded. The search was carried out with the descriptors in German, Spanish, French, Italian, Mandarin, Portuguese and English; but only studies written in English were found to meet the established criteria. Articles covering the period 2000-2017 were selected; however, articles prior to this period with great relevance were included in this study. DISCUSSION Based on the collected research, it was identified that there are several methods in the use of artificial intelligence to help the screening of risk groups of osteoporosis or fractures. However, such systems were limited to a specific ethnic group, gender or age. For future research, new challenges are presented. CONCLUSIONS It is necessary to develop research with the unification of different databases and grouping of the various attributes and clinical factors, in order to reach a greater comprehensiveness in the identification of risk groups of osteoporosis. For this purpose, the use of any predictive tool should be performed in different populations with greater participation of male patients and inclusion of a larger age range for the ones involved. The biggest challenge is to deal with all the data complexity generated by this unification, developing evidence-based standards for the evaluation of the most significant risk factors.
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Affiliation(s)
- Agnaldo S. Cruz
- Centro de Tecnologia, Universidade Federal do Rio Grande do Norte UFRN, Av. Salgado Filho, Natal, Brazil
| | - Hertz C. Lins
- Laboratory of Technological Innovation in Healthcare, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Ricardo V. A. Medeiros
- Laboratory of Technological Innovation in Healthcare, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - José M. F. Filho
- Laboratory of Technological Innovation in Healthcare, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Sandro G. da Silva
- Centro de Tecnologia, Universidade Federal do Rio Grande do Norte UFRN, Av. Salgado Filho, Natal, Brazil
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Bach M, Werner A, Żywiec J, Pluskiewicz W. The study of under- and over-sampling methods’ utility in analysis of highly imbalanced data on osteoporosis. Inf Sci (N Y) 2017. [DOI: 10.1016/j.ins.2016.09.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saly D, Yang A, Triebwasser C, Oh J, Sun Q, Testani J, Parikh CR, Bia J, Biswas A, Stetson C, Chaisanguanthum K, Wilson FP. Approaches to Predicting Outcomes in Patients with Acute Kidney Injury. PLoS One 2017; 12:e0169305. [PMID: 28122032 PMCID: PMC5266278 DOI: 10.1371/journal.pone.0169305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
Despite recognition that Acute Kidney Injury (AKI) leads to substantial increases in morbidity, mortality, and length of stay, accurate prognostication of these clinical events remains difficult. It remains unclear which approaches to variable selection and model building are most robust. We used data from a randomized trial of AKI alerting to develop time-updated prognostic models using stepwise regression compared to more advanced variable selection techniques. We randomly split data into training and validation cohorts. Outcomes of interest were death within 7 days, dialysis within 7 days, and length of stay. Data elements eligible for model-building included lab values, medications and dosages, procedures, and demographics. We assessed model discrimination using the area under the receiver operator characteristic curve and r-squared values. 2241 individuals were available for analysis. Both modeling techniques created viable models with very good discrimination ability, with AUCs exceeding 0.85 for dialysis and 0.8 for death prediction. Model performance was similar across model building strategies, though the strategy employing more advanced variable selection was more parsimonious. Very good to excellent prediction of outcome events is feasible in patients with AKI. More advanced techniques may lead to more parsimonious models, which may facilitate adoption in other settings.
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Affiliation(s)
- Danielle Saly
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Alina Yang
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Corey Triebwasser
- Yale University School of Public Health, New Haven, CT, United States of America
| | - Janice Oh
- Yale University School of Public Health, New Haven, CT, United States of America
| | - Qisi Sun
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Jeffrey Testani
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Chirag R. Parikh
- Yale University School of Medicine, New Haven, CT, United States of America
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America
- Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT, United States of America
| | - Joshua Bia
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America
| | - Aditya Biswas
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America
| | | | | | - F. Perry Wilson
- Yale University School of Medicine, New Haven, CT, United States of America
- Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States of America
- Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT, United States of America
- * E-mail:
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Lin JH, Chien LN, Tsai WL, Chen LY, Hsieh YC, Chiang YH. Reoperation rates of anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical degenerative diseases: a population-based cohort study in Taiwan. Spine J 2016; 16:1428-1436. [PMID: 27520080 DOI: 10.1016/j.spinee.2016.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 05/13/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The reoperation (reop) rate is a crucial indicator of the efficacy of an operation; however, studies on the reop rates of anterior cervical discectomy and fusion (ACDF) or posterior laminoplasty (LMP) for treating multilevel cervical degenerative diseases (MCDDs) are scant. PURPOSE This study aimed to compare the reop rates and safety of ACDF and LMP for MCDD treatment. STUDY DESIGN This is a retrospective population-based cohort study. PATIENT SAMPLE Our sample consists of patients who underwent ACDF and LMP treatment. OUTCOME MEASURES Reop rate, risk of pneumonia, sepsis, surgery-related complications, and death. METHODS A total of 6,605 patients who underwent ACDF and 1,578 patients who underwent LMP for MCDD treatment from 2001 to 2011 were selected from the Taiwan National Health Insurance Research Database. Cox proportional hazard models were performed to compare the clinical outcomes of the patients who underwent ACDF with those of the patients who underwent LMP. RESULTS Long-term reop rates (per 100 person-month) were slightly Anterior cervical discectomy and fusion; in the patients who underwent ACDF (0.04 [95% confidence interval, CI: 0.03-0.05]) than in those who underwent LMP (0.06 [95% CI: 0.04-0.08]), with adjusted hazard ratio (HR) of 1.43 (95% CI: 0.96-2.11, p=.08), although short-term reop rates were significantly higher in the LMP group (0.41 [95% CI: 0.33-0.51]) than in the ACDF group (0.09 [95% CI: 0.07-0.11]), with adjusted HR of 4.81 (95% CI: 3.46-6.69, p<.001). Patients who underwent LMP had a lower risk of pneumonia, sepsis, surgery-related complications, and death than did those who underwent ACDF within a year of follow-up. The results after adjustment for all covariates showed that osteoarthritis (adjusted HR=2.07, 95% CI: 1.40-3.06, p<.01) was associated with reop risk in the patients who underwent ACDF, and diabetes (adjusted HR=3.27, 95% CI: 1.12-9.54, p=.03) was associated with reop risk in the patients who underwent LMP. CONCLUSIONS There was no significantly higher incidence rate of reop between the patients who underwent LMP and those who underwent ACDF after 1-year follow-up; however, ACDF was associated with a higher rate of 1-year complications and mortality compared with LMP. LMP might be considered as a treatment option for MCDD but could not be appropriate for patients with cervical kyphotic deformity.
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Affiliation(s)
- Jiann-Her Lin
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Wan-Ling Tsai
- Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Graduate Institute of Neural Regenerative Medicine, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Li-Ying Chen
- Health and Clinical Research Center, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
| | - Yi-Chen Hsieh
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan.
| | - Yung-Hsiao Chiang
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St, Xinyi District, Taipei 11031, Taiwan
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Choi SB, Park JS, Chung JW, Kim SW, Kim DW. Prediction of ATLS hypovolemic shock class in rats using the perfusion index and lactate concentration. Shock 2016; 43:361-8. [PMID: 25394246 DOI: 10.1097/shk.0000000000000296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is necessary to quickly and accurately determine Advanced Trauma Life Support (ATLS) hemorrhagic shock class for triage in cases of acute hemorrhage caused by trauma. However, the ATLS classification has limitations, namely, with regard to primary vital signs. This study identified the optimal variables for appropriate triage of hemorrhage severity, including the peripheral perfusion index and serum lactate concentration in addition to the conventional primary vital signs. To predict the four ATLS classes, three popular machine learning algorithms with four feature selection methods for multicategory classification were applied to a rat model of acute hemorrhage. A total of 78 anesthetized rats were divided into four groups for ATLS classification based on blood loss (in percent). The support vector machine one-versus-one model with the Kruskal-Wallis feature selection method performed best, with 80.8% accuracy, relative classifier information of 0.629, and a kappa index of 0.732. The new hemorrhage-induced severity index (lactate concentration/perfusion index), diastolic blood pressure, mean arterial pressure, and the perfusion index were selected as the optimal variables for predicting the four ATLS classes by support vector machine one-versus-one with the Kruskal-Wallis method. These four variables were also selected for binary classification to predict ATLS classes I and II versus III and IV for blood transfusion requirement. The suggested ATLS classification system would be helpful to first responders by indicating the severity of patients, allowing physicians to prepare suitable resuscitation before hospital arrival, which could hasten treatment initiation.
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Affiliation(s)
- Soo Beom Choi
- *Department of Medical Engineering, Yonsei University College of Medicine; †Brain Korea 21 PLUS Project for Medical Science, Yonsei University; ‡Department of Medicine, Yonsei University College of Medicine; and §Graduate Program in Biomedical Engineering, Yonsei University, Seoul, Republic of Korea
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Development and validation of osteoporosis prescreening model for Iranian postmenopausal women. J Diabetes Metab Disord 2015; 14:12. [PMID: 25821747 PMCID: PMC4376506 DOI: 10.1186/s40200-015-0140-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 02/21/2015] [Indexed: 11/27/2022]
Abstract
Background Studies have indicated that the commonly used osteoporosis prescreening tools are not appropriate for use in every nation. This study was designed to develop and validate a prescreening model for bone mineral densitometry among Iranian postmenopausal women. Methods From 13613 individuals who were referred for bone mineral densitometry in Shariati hospital in Tehran, 8644 postmenopausal women were considered for the study after excluding men and premenopausal women. Questionnaires regarding the risk factors for osteoporosis were filled for each individual. Bone mineral density at the lumbar vertebrae (L2-L4), femoral neck and total femur was measured by dual X-ray absorptiometry. Using holdout validation, the study sample was divided into two parts; training set (5705) and test set (2939). Logistic regression analysis was performed on the training set. A scoring model was developed and tested in the test set. Results Based on the training set, a seven-variable model named OPMIP (Osteoporosis Prescreening Model for Iranian Postmenopausal women) was developed with C statistics (area under curve) of 0.72. Using a cut-off of -2.5 for the model, the sensitivity, specificity, positive predictive value and negative predictive value were 72%, 59.5%, 64% and 69% respectively. The model performance was tested in the test set. OPMIP correctly classified 67.10% of cases with a sensitivity and specificity of 73.2% and 61%. Conclusions In order to appropriately refer patients for a bone mineral densitometry, OPMIP can be used as a prescreening tool in Iranian Postmenopausal women.
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Chung JW, Kim WJ, Choi SB, Park JS, Kim DW. Screening for pre-diabetes using support vector machine model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2472-5. [PMID: 25570491 DOI: 10.1109/embc.2014.6944123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The global prevalence of diabetes is rapidly increasing. Studies support screening and interventions for pre-diabetes, which results in serious complications and diabetes. This study aimed at developing an intelligence-based screening model for pre-diabetes that could assist with decreasing the prevalence of diabetes through early identification and subsequent interventions. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used, excluding subjects with diabetes. The KNHANES 2010 data (n = 4,685) were used for training and internal validation, while data from KNHANES 2011 (n = 4,566) were used for external validation. We developed a model to screen for pre-diabetes using support vector machine (SVM), and performed a systematic evaluation of the SVM model using internal and external validation. We compared the performance of the SVM model with that of a screening score model based on logistic regression analysis for pre-diabetes that had been developed previously. Backward elimination logistic regression resulted in associations between pre-diabetes and age, sex, waist circumference, body mass index, alcohol intake, family history of diabetes, and hypertension. The areas under the curves (AUCs) for the SVM model in the internal and external datasets were 0.761 and 0.731, respectively, while the AUCs for the screening score model were 0.734 and 0.712, respectively. The SVM model developed in this study performed better than the screening score model that had been developed previously and may be more effective for pre-diabetes screening.
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Screening for prediabetes using machine learning models. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:618976. [PMID: 25165484 PMCID: PMC4140121 DOI: 10.1155/2014/618976] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/08/2014] [Indexed: 12/30/2022]
Abstract
The global prevalence of diabetes is rapidly increasing. Studies support the necessity of screening and interventions for prediabetes, which could result in serious complications and diabetes. This study aimed at developing an intelligence-based screening model for prediabetes. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used, excluding subjects with diabetes. The KNHANES 2010 data (n = 4685) were used for training and internal validation, while data from KNHANES 2011 (n = 4566) were used for external validation. We developed two models to screen for prediabetes using an artificial neural network (ANN) and support vector machine (SVM) and performed a systematic evaluation of the models using internal and external validation. We compared the performance of our models with that of a screening score model based on logistic regression analysis for prediabetes that had been developed previously. The SVM model showed the areas under the curve of 0.731 in the external datasets, which is higher than those of the ANN model (0.729) and the screening score model (0.712), respectively. The prescreening methods developed in this study performed better than the screening score model that had been developed previously and may be more effective method for prediabetes screening.
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