XAttn-BMD: Multimodal Deep Learning with Cross-Attention for Femoral Neck Bone Mineral Density Estimation

Poor bone health is a significant public health concern, and low bone mineral density (BMD) leads to an increased fracture risk, a key feature of osteoporosis. We present XAttn-BMD (Cross-Attention BMD), a multimodal deep learning framework that predicts femoral neck BMD from hip X-ray images and structured clinical metadata. It utilizes a novel bidirectional cross-attention mechanism to dynamically integrate image and metadata features for cross-modal mutual reinforcement. A Weighted Smooth L1 loss is tailored to address BMD imbalance and prioritize clinically significant cases. Extensive experiments on the data from the Hertfordshire Cohort Study show that our model outperforms the baseline models in regression generalization and robustness. Ablation studies confirm the effectiveness of both cross-attention fusion and the customized loss function. Experimental results show that the integration of multimodal data via cross-attention outperforms naive feature concatenation without cross-attention, reducing MSE by 16.7%, MAE by 6.03%, and increasing the R2 score by 16.4%, highlighting the effectiveness of the approach for femoral neck BMD estimation. Furthermore, screening performance was evaluated using binary classification at clinically relevant femoral neck BMD thresholds, demonstrating the model's potential in real-world scenarios.