Instant vertebral assessment (IVA) in combination with bone densitometry (BDM): A new standard in the diagnosis of osteoporosis?
Bibliographic record
Abstract
432 Objectives: Prevalent vertebral fractures constitute a significant risk factor for future fractures, which is independent of the bone density. New developments in DEXA machines allow visual and software-based detection of vertebral fractures. We aimed to determine the added value of IVA performed immediately after BDM. Methods: All patients referred to our university medical center department for BDM also underwent IVA om a Hologic Discovery A bone densitometer. Studies were analyzed by 3 experienced operators and physicians. The frequency of vertebral fractures was determined in the the entire cohort and in various subgroups. Referring physicians were asked for their opinion on the added value of IVA using a short questionaire. Results: 958 patients were included (64% females, 52% postmenopausal), 29% were assessed because of primary osteoporosis, 71% for secondary osteoporosis. 30% used corticosteroids. In 2% IVA was not possible due to extreme adipositas or deformities. In 71% T4 and in 86% T5 was the upper vertebral level that could be assessed. The main finding in this cohort was a prevalence of vertebral fractures of 26%. In 68% of these patients this fracture was unknown. We found a mean of 1.8 vertebral fractures per patient. Even after excluding mild fractures (=20-25% heightloss) still 17% of the patients had moderate (>25%) or severe (>40% heightloss) vertebral fractures. In the 27% with normal bone density the vertebral fracture prevalence was still 18%, in the 43% with ostopenia 23%, and in the 29% with osteoporisis 36%. In primary osteoporosis the vertebral fracture prevalence was 45%, in secondary osteoporosis 33%. Referring physicians reported that in 58% IVA results increased their understanding, and in 27% had an impact on treatment. Conclusions: IVA added to BMD is a very convenient and patient friendly diagnostic tool with a high diagnostic yield as the method detected vertebral fractures in 1 out of 4 patients. In 2/3 of these cases these fractures were unknown. In 18% of patients with normal bone density vertebral fractures were detected.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".