Spine age derived from DXA vertebral fracture assessment images predicts incident fractures and mortality: the Manitoba Bone Mineral Density Registry
Authors' conclusion
In summary, accelerated spine aging detected from DXA VFA predicts fracture and mortality risk independently of age, clinical risk factors, VF, spine structural artifacts, and BMD in individuals at high risk of fracture, supporting its potential to enhance fracture risk assessment.
Study context
- Population
- Adults aged ≥50 who underwent DXA vertebral fracture assessment (VFA) in Manitoba, Canada (2010–2023); test set completed DXA before 2017test set
- Participants
- 8,810 adults
- Exposure
- Per SD increase in predicted spine age difference
- Outcome
- Incident fractures (any, nonvertebral, major osteoporotic, hip) and mortality
- Follow-up
- Mean 3.9 yr
Methodological detailsdeep learning (convolutional neural network), registry-based, CNN trained in Korean cohort (VERTE-X, n = 10 341); fine-tuned on 20% random subset of 27 601 Manitoba adults
- Deep learning (convolutional neural network)
- Registry-based
- CNN trained in Korean cohort (VERTE-X, n = 10 341); fine-tuned on 20% random subset of 27 601 Manitoba adults
Main finding
As reported in the abstract
- Any fracture, aHR per SD PAD
- 1.11
- Nonvertebral fracture, aHR per SD PAD
- 1.10
- Major osteoporotic fracture, aHR per SD PAD
- 1.12
- Hip fracture, aHR per SD PAD
- 1.25
- Mortality, aHR per SD PAD
- 1.12
Observational data: associations, not effects.
Further findings
Events during follow-up · mean follow-up 3.9 yr
- Incident fractures
- 899
- Deaths
- 969
Spine age vs chronological age
- Correlation (r)
- 0.89
- Mean difference, yr (SD 3.4)
- 0.0
Factors associated with higher PAD
- Vertebral fracture (VFs), yr
- +1.02
- Nonvertebral fracture history
- +0.22
- Generalized spine structural artifacts
- +1.45
- Smoking
- +1.20
- Lower FN BMD, per T-score decrement
- +0.60
- PAD variance explained collectively
- 66%
Original publication
Spine age derived from DXA vertebral fracture assessment images predicts incident fractures and mortality: the Manitoba Bone Mineral Density Registry. J Bone Miner Res. Published 18 December 2025. doi:10.
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