SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2014
Performance of risk assessment instruments for predicting osteoporotic fracture risk: a systematic review.
Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Performance of predictive tools to identify individuals at risk of non-traumatic fracture: a systematic review, meta-analysis, and meta-regression.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Pooled it
- Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015Pooled it
- Stability-Driven Osteoporosis Screening: Multi-View Consensus Feature Selection with External Validation and Sensitivity Analysis.Journal of clinical medicine · 2026Article
- Hip Fractures: Clinical, Biomaterial and Biomechanical Insights into a Common Health Challenge.Bioengineering (Basel, Switzerland) · 2025Review
- On challenges in clinical assessment of hip fracture risk using image-based biomechanical modelling: a critical review.Journal of bone and mineral metabolism · 2021Review
- COPD as an independent risk factor for osteoporosis and fractures.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020Article
- Homogeneity in prediction of survival probabilities for subcategories of hipprosthesis data: the Nordic Arthroplasty Register Association, 2000-2013.Clinical epidemiology · 2019Article
- Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature.Diagnostic and prognostic research · 2019Review
- Diversity in fall characteristics hampers effective prevention: the precipitants, the environment, the fall and the injury.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Article
- External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study.BMJ (Clinical research ed.) · 2017Article
- Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study.RMD open · 2017Article
- Analysis of fracture healing in osteopenic bone caused by disuse: experimental study.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologica · 2016Article
- Article
- Fragility fracture: recent developments in risk assessment.Therapeutic advances in musculoskeletal disease · 2015Review
- Comparison of fracture risk prediction by the US Preventive Services Task Force strategy and two alternative strategies in women 50-64 years old in the Women's Health Initiative.The Journal of clinical endocrinology and metabolism · 2014Article
- Novel assessment tools for osteoporosis diagnosis and treatment.Current osteoporosis reports · 2014Review
- Bone: Which model to predict fracture risk?Nature reviews. Endocrinology · 2014Article
- External validation of the Garvan nomograms for predicting absolute fracture risk: the Tromsø study.PloS one · 2014Article
- Hospitalization in High Fracture Risk Older Adults with Osteoporosis Using the Safe Functional Motion Test: A Longitudinal Analysis.Gerontology & geriatric medicineArticle
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
unlabelledWe systematically reviewed the literature on the performance of osteoporosis absolute fracture risk assessment instruments. Relatively few studies have evaluated the calibration of instruments in populations separate from their development cohorts, and findings are mixed. Many studies had methodological limitations making susceptibility to bias a concern.
introductionThe aim of this study was to systematically review the literature on the performance of osteoporosis clinical fracture risk assessment instruments for predicting absolute fracture risk, or calibration, in populations other than their derivation cohorts.
methodsWe performed a systematic review, and MEDLINE, Embase, Cochrane Library, and multiple other literature sources were searched. Inclusion and exclusion criteria were applied and data extracted, including information about study participants, study design, potential sources of bias, and predicted and observed fracture probabilities.
resultsA total of 19,949 unique records were identified for review. Fourteen studies met inclusion criteria. There was substantial heterogeneity among included studies. Six studies assessed the WHO's Fracture Risk Assessment (FRAX) instrument in five separate cohorts, and a variety of risk assessment instruments were evaluated in the remainder of the studies. Approximately half found good instrument calibration, with observed fracture probabilities being close to predicted probabilities for different risk categories. Studies that assessed the calibration of FRAX found mixed performance in different populations. A similar proportion of studies that evaluated simple risk assessment instruments (≤5 variables) found good calibration when compared with studies that assessed complex instruments (>5 variables). Many studies had methodological features making them susceptible to bias.
conclusionsFew studies have evaluated the performance or calibration of osteoporosis fracture risk assessment instruments in populations separate from their development cohorts. Findings are mixed, and many studies had methodological limitations making susceptibility to bias a possibility, raising concerns about use of these tools outside of the original derivation cohorts. Further studies are needed to assess the calibration of instruments in different populations prior to widespread use.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.