AI-driven bone mineral density prediction from chest x-rays and its association with obstructive sleep apnea

With an increasing aging population, the prevalence of chronic comorbidities is on the rise. The potential relationship between obstructive sleep apnea (OSA) and osteoporosis has garnered significant attention. Most studies examining the association between these two conditions have relied on dual-energy X-ray absorptiometry (DXA) to evaluate bone mineral density (BMD). Although DXA is considered the gold standard for BMD assessment, it does not reflect overall skeletal health. The limitations of conventional measurements are particularly pronounced in patients with multisystemic diseases, such as OSA. To address these limitations, we applied VeriOsteo™OP software to predict lumbar spine BMD and T-scores from chest X-ray (CXR) images. In addition, we examined the relationship between these bone health metrics and OSA. A total of 70,395 patients who underwent CXR examinations at Tungs' Taichung MetroHarbor Hospital from 2017 to 2022 were included. Eligible samples were selected based on the presence of an OSA ICD-10-CM diagnosis code along with DXA results. By incorporating variables, such as gender, age, Body Mass Index (BMI), and T-score, we used multiple machine learning models, including logistic regression, random forest, and XGBoost, to analyze the risk for OSA. The results indicated that when the BMI range was controlled, the predictive contribution of the T-score became significant. For some models, the area under the curve (AUC) reached over 85% in both the training and validation datasets. This suggests a notable association between T-score and OSA, which is maintained when confounding variables such as BMI are controlled. This study highlights the potential of artificial intelligence (AI) technology using CXR imaging for osteoporosis screening. Combining CXR with machine learning models enables the assessment of OSA risk and offers a cost-effective, radiation-free screening tool with promising clinical applications.