Osteoporosis prediction using lumbar CT Hounsfield units: comparative performance and clinical implications of seven machine learning models

ML models using L1-L4 HU values can aid in osteoporosis screening. KNN provided the most robust and balanced diagnostic performance, while Logistic Regression and SVM offered stable threshold-based classification. These findings support the utility of CT-based ML approaches in preoperative spinal surgery settings, particularly where DXA is unavailable or limited.