BackgroundIt is known that bone mineral density (BMD) predicts the fracture's risk only partially and the severity and number of vertebral fractures are predictive of subsequent osteoporotic fractures (OF). Spinal deformity index (SDI) integrates the severity and number of morphometric vertebral fractures. Nowadays, there is interest in developing algorithms that use traditional statistics for predicting OF. Some studies suggest their poor sensitivity. Artificial Neural Networks (ANNs) could represent an alternative. So far, no study investigated ANNs ability in predicting OF and SDI. The aim of the present study is to compare ANNs and Logistic Regression (LR) in recognising, on the basis of osteoporotic risk-factors and other clinical information, patients with SDI≥1 and SDI≥5 from those with SDI = 0.MethodologyWe compared ANNs prognostic performance with that of LR in identifying SDI≥1/SDI≥5 in 372 women with postmenopausal-osteoporosis (SDI≥1, n = 176; SDI = 0, n = 196; SDI≥5, n = 51), using 45 variables (44 clinical parameters plus BMD). ANNs were allowed to choose relevant input data automatically (TWIST-system-Semeion). Among 45 variables, 17 and 25 were selected by TWIST-system-Semeion, in SDI≥1 vs SDI = 0 (first) and SDI≥5 vs SDI = 0 (second) analysis. In the first analysis sensitivity of LR and ANNs was 35.8% and 72.5%, specificity 76.5% and 78.5% and accuracy 56.2% and 75.5%, respectively. In the second analysis, sensitivity of LR and ANNs was 37.3% and 74.8%, specificity 90.3% and 87.8%, and accuracy 63.8% and 81.3%, respectively.ConclusionsANNs showed a better performance in identifying both SDI≥1 and SDI≥5, with a higher sensitivity, suggesting its promising role in the development of algorithm for predicting OF.

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Vitamin D exerts extra-skeletal actions, given the presence in many different tissues of its nuclear receptors controlling transcription of genes related to autoimmune diseases and its endocrine effects mainly affecting calcium metabolism. Many papers have highlighted its ability to reduce infections and to modulate innate and adaptive cellular immunity, with an inverse correlation between the incidence of airway infections and serum vitamin D levels. During the COVID-19 epidemic, not only the elderly confined to the home, with no physical activity, minimal sun exposure and physiological reduction of the UV-radiation induced activation of vitamin D, but also people suffering from fragility fractures, often with comorbidities and treatments with bone-loss side effects (primarily steroids), as well as people in environments at high risk (such as patients and staff in hospitals), should take vitamin D supplements as an important step in the prevention of infections and their spread. In any case, randomised studies should be conducted on large populations to give value to this therapeutic strategy, given the lack of unequivocal of not univocal data on the immune supportive role of vitamin D, on the dose to be administered and blood levels to be achieved.