Development and evaluation of a machine learning model for osteoporosis risk prediction in Korean women

The aim of this study was to develop a machine learning (ML) model for classifying osteoporosis in Korean women based on a large-scale population cohort study. This study also aimed to assess ML model performance compared with traditional osteoporosis screening tools. Furthermore, this study aimed to examine the factors influencing the risk of osteoporosis through variable importance.

Data was collected from 4199 women aged 40-69 years in the baseline survey of the Ansan and Ansung cohort of the Korean Genome and Epidemiology Study. Osteoporosis was set as the dependent variable to develop ML classification models. Independent variables included 122 factors related to osteoporosis risk, such as socio-demographic characteristics, anthropometric parameters, lifestyle factors, reproductive factors, nutrient intakes, diet quality indices, medical history, medication history, family history, biochemical parameters, and genetic factors. The six classification models were developed using ML techniques, including decision tree, random forest, multilayer perceptron, support vector machine, light gradient boosting machine, and extreme gradient boosting (XGBoost). The six ML classification models were compared with two traditional osteoporosis screening tools, including the osteoporosis risk assessment instrument (ORAI) and the osteoporosis self-assessment tool (OST). The ML model performances were evaluated and compared using the confusion matrix and area under the curve (AUC) metrics. Variable importance was assessed using the XGBoost technique to investigate osteoporosis risk factors.

The XGBoost model showed the highest performance out of the six ML classification models, with an accuracy of 0.705, precision of 0.664, recall of 0.830, and F1 score of 0.738. Moreover, the XGBoost model showed a higher performance on AUC than ORAI and OST. Variable importance scores were identified for 69 out of the 122 variables associated with osteoporosis risk factors. Age at menopause ranked first in variable importance. Variables of arthritis, physical activities, hypertension, education level, income level; alcohol intake, potassium intake, homeostatic model assessment for insulin resistance; energy intake, vitamin C intake, gout; and dietary inflammatory index ranked in the top 20 out of the 69 variables, using the XGBoost technique.

This study found that an XGBoost model can be utilized to classify osteoporosis in Korean women. Age at menopause is a significant factor in osteoporosis risk, followed by arthritis, physical activities, hypertension, and education level.