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This study evaluates whether AI-assisted chest radiographs can enable opportunistic osteoporosis screening for Japanese women aged 50 and older in a cost-effective way. An economic model estimates cost per QALY gained (2024 Japanese Yen) versus no screening, using AI diagnostic performance and Japan osteoporosis guideline–aligned patient trajectories.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cost-effectiveness-of-opportunistic-osteoporosis-screening-using-artificial-intelligence-assisted-chest-radiographs-in-japan/434850/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cost-effectiveness-of-opportunistic-osteoporosis-screening-using-artificial-intelligence-assisted-chest-radiographs-in-japan/434850.png","ImageObject",300,407,{"name":92,"@type":93},"Cart","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is opportunistic osteoporosis screening considered in this study?","Question",{"text":112,"@type":113},"Conventional osteoporosis screening can miss diagnoses, leading to delayed early treatment. Chest radiographs are routinely used in Japan, and AI may enable opportunistic use for osteoporosis detection without separate screening programs.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the study measure cost-effectiveness?",{"text":117,"@type":113},"It uses an economic model to estimate the cost per quality-adjusted life year (QALY) gained in 2024 Japanese Yen, comparing AI-assisted screening followed by treatment versus no screening.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the main cost-effectiveness findings?",{"text":121,"@type":113},"Nationwide, the estimated cost per QALY gained was ¥189,713 for women aged 50 and older, below the ¥5 million threshold. In Kure City, opportunistic screening was dominant, and in a lower-incidence scenario the cost per QALY was still below the threshold.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434850,1791085818,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Osteoporosis and Sarcopenia 11 (2025) 127–136  \nContents lists available at ScienceDirect Osteoporosis and Sarcopenia  \njournal [homepage:](homepage: www.elsevier.com/locate/afos)[ www.elsevier.com/locate/afos](homepage: www.elsevier.com/locate/afos)  \n| Original article\u003Cbr>Cost-effectiveness of opportunistic osteoporosis screening using artificial-intelligence assisted chest radiographs in Japan |  |  |  | |\n| --- | --- | --- | --- | --- |\n| Jean-Yves Reginster a, Takahiko Hamasaki b, Saeko Fujiwara c, Majed Alokail a,\u003Cbr>Mickael Hiligsmannd,*  |  |  |  |  |\n| abc d | Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia\u003Cbr>Chugoku Rosai Hospital, Kure, Hiroshima, Japan\u003Cbr>Department of Pharmacy, Yasuda Women’s University, Hiroshima, Japan\u003Cbr>Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands |  |  |  |\n| A R T I C L E I N F O |  |  | A B S T R A C T |  |\n| Keywords:\u003Cbr>Artificial intelligence Chest radiographs Cost-effectiveness Osteoporosis Screening |  |  | Objectives: Osteoporosis is often undiagnosed due to the shortcomings of conventional screening, resulting in missed chances for early treatment. Advances in artificial intelligence (AI), particularly deep learning applied to chest X-rays, offer a new opportunity for opportunistic screening. This study assesses the cost-effectiveness of this approach in Japanese women aged ≥ 50 years.\u003Cbr>Methods: An economic model estimated the cost per quality-adjusted life year (QALY) gained (in 2024 Japanese Yen, ¥) for a strategy involving AI-assisted chest X-ray screening followed by treatment, compared to no screening. Patient trajectories were modeled using the AI system’s diagnostic performance and aligned with the Japanese osteoporosis guidelines. Analyses were conducted for Japan overall, in Kure City (a high-fractureincidence area), and in a lower-incidence scenario. Real-world medication persistence, the probabilities of dual-energy X-ray absorptiometry examination after screening detection, and treatment initiation rates were incorporated.\u003Cbr>Results: Nationwide in Japan, the cost per QALY gained from opportunistic osteoporosis screening was estimated at ¥189,713 for women aged ≥ 50, substantially lower than the accepted cost-effectiveness threshold of ¥5 million. In Kure City, opportunistic screening was dominant (lower total costs for more QALYs). In the lowerincidence scenario, 25% below the national average, the cost per QALY was ¥1,055,095, remaining below the threshold. Results were robust across all age-specific populations and in sensitivity analyses.\u003Cbr>Conclusions: Leveraging AI-assisted chest X-rays for incidental osteoporosis detection demonstrates strong economic viability for older Japanese women. This approach also proves to be a dominant strategy in areas with elevated fracture rates. |  |\n\n1. Introduction  \nJapan is one of the few countries that recommend universal screening for lung cancer [1]. Given the routine use of chest radiographsin such programs, there is growing interest in exploring their potential for additional applications, such as osteoporosis screening. While chest radiographs are currently not used for osteoporosis screening, they present a valuable opportunity to help address the growing burden of osteoporosis and fragility fractures. Recent advancements in artificial intelligence (AI), and deep learning models in particular, offer a promising avenue for opportunistic screening, by utilizing existing imaging  \nresources and expanding access without requiring separate screening initiatives. Deep learning models have demonstrated the potential to assess bone health through radiographs, providing a scalable and potentially cost-effective alternative for opportunistic osteoporosis screening [2,3].  \nIn Japan, population-based osteoporosis screening is currently offered only every five years to select age groups,","cbCailODwkQwVeuU","https://ap.wps.com/l/cbCailODwkQwVeuU","pdf",1256089,"English","# Introduction\n## Background on osteoporosis and existing screening limitations\n## Rationale for opportunistic screening using chest radiographs\n# Methods\n## Economic model and QALY calculation\n## Patient pathways and parameter inputs\n## Scenario analyses and sensitivity testing\n# Results\n## Nationwide cost-effectiveness in Japan\n## City-level outcomes (Kure)\n## Lower-incidence scenario and robustness\n# Conclusions","[{\"question\":\"Why is opportunistic osteoporosis screening considered in this study?\",\"answer\":\"Conventional osteoporosis screening can miss diagnoses, leading to delayed early treatment. Chest radiographs are routinely used in Japan, and AI may enable opportunistic use for osteoporosis detection without separate screening programs.\"},{\"question\":\"How does the study measure cost-effectiveness?\",\"answer\":\"It uses an economic model to estimate the cost per quality-adjusted life year (QALY) gained in 2024 Japanese Yen, comparing AI-assisted screening followed by treatment versus no screening.\"},{\"question\":\"What were the main cost-effectiveness findings?\",\"answer\":\"Nationwide, the estimated cost per QALY gained was ¥189,713 for women aged 50 and older, below the ¥5 million threshold. In Kure City, opportunistic screening was dominant, and in a lower-incidence scenario the cost per QALY was still below the threshold.\"}]","Cost-effectiveness of opportunistic osteoporosis screening using artificial-intelligence assisted chest radiographs in Japan | PDF",1790670793,25]