ArticleAging clinical and experimental research2025
Cost-effectiveness of opportunistic osteoporosis screening using chest radiographs with deep learning in Germany.
Article in Aging clinical and experimental research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Cost-effectiveness of artificial intelligence interventions for musculoskeletal disorders of the spine: a systematic review.Rheumatology international · 2026Pooled it
- Artificial intelligence for opportunistic screening of osteoporosis across multiple imaging modalities: a systematic review.Frontiers in medicine · 2026Pooled it
- Single-component imaging and ultrasound-based tools for the assessment of fracture risk.Nature reviews. Rheumatology · 2026Review
- Assessing the Value for Money of AI-Assisted Technologies for Older Adults: Scoping Review of Economic Evaluations.Journal of medical Internet research · 2026Article
- Consensus statement on the application of artificial intelligence in osteoporosis screening and management: perspectives from the Asia-Pacific region.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Artificial intelligence vs human opportunistic detection of vertebral fractures in routine CT scans: results of a pilot study.Hormones (Athens, Greece) · 2026Article
- Clinical and economic impact of deep learning-enhanced opportunistic osteoporosis screening using chest radiographs with and without the osteoporosis self-assessment tool for Asians (OSTA).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Canal-to-Bone Ratio as an Independent Predictor of Hip Bone Mineral Density Scores: A Retrospective Analysis.The Eurasian journal of medicine · 2026Article
- Article
- Artificial Intelligence in Rheumatology: From Algorithms to Clinical Impact in Osteoporosis and Chronic Inflammatory Rheumatic Diseases.Journal of clinical medicine · 2026Article
- Cost-effectiveness of opportunistic osteoporosis screening using artificial-intelligence assisted chest radiographs in Japan.Osteoporosis and sarcopenia · 2025Article
- Beyond Bone Mineral Density: Real-World Fracture Risk Profiles and Therapeutic Gaps in Postmenopausal Osteoporosis.Diagnostics (Basel, Switzerland) · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOsteoporosis is often underdiagnosed due to limitations in traditional screening methods, leading to missed early intervention opportunities. AI-driven screening using chest radiographs could improve early detection, reduce fracture risk, and improve public health outcomes.
aimsTo assess the cost-effectiveness of deep learning models (hereafter referred to as AI-driven) applied to chest radiographs for opportunistic osteoporosis screening in German women aged 50 and older.
methodsA decision tree and microsimulation Markov model were used to calculate the cost per quality-adjusted life year (QALY) gained (€2024) for screening with AI-driven chest radiographs followed by treatment, compared to no screening and treatment. Patient pathways were based on AI model accuracy and German osteoporosis guidelines. Women with a fracture risk below 5% received no treatment, those with 5-10% risk received alendronate, and women 65 + with a risk above 10% received sequential treatment starting with romosozumab. Data was validated by a German clinical expert, incorporating real-world treatment persistence, DXA follow-up rates, and treatment initiation. Sensitivity analyses assessed parameter uncertainty.
resultsThe cost per QALY gained from screening was €13,340, far below the typical cost-effectiveness threshold of €60,000. Optimizing follow-up, treatment initiation, and medication adherence further improved cost-effectiveness, with dominance achievable by halving medication non-persistence, and in women aged 50-64.
conclusionAI-driven chest radiographs for opportunistic osteoporosis screening is a cost-effective strategy for German women aged 50+, with the potential to significantly improve public health outcomes, reduce fracture burdens and address healthcare disparities. Policymakers and clinicians should consider implementing this scalable and cost-effective screening strategy.
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