Local fragility index and Radiomics-lite modeling of CT-Derived Hounsfield units for osteoporosis risk assessment in spine surgery patients

The LFI captures vertebral heterogeneity and complements mean HU, thereby enhancing osteoporosis risk stratification. Building on this framework, a simplified Radiomics-lite + Clinical model further improved discriminative performance and decision-analytic utility, offering a scalable approach for CT-based assessment in patients undergoing spine surgery. This approach may directly inform surgical planning (e.g., screw augmentation, extended fusion levels) and perioperative management of osteoporosis. As this outcome-agnostic, hypothesis-generating analysis was benchmarked to DXA rather than clinical endpoints, prospective validation against fractures and instrumentation-related complications is needed before clinical use.