ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2014
FRAX provides robust fracture prediction regardless of socioeconomic status.
Article 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 16 papers, 8 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- The 2024 UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2025Guideline
- Pooled it
- Pooled it
- UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2022Guideline
- Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Pooled it
- European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Guideline
- A systematic review of intervention thresholds based on FRAX : A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation.Archives of osteoporosis · 2016Pooled it
- Risk Assessment Tools for Osteoporosis Screening in Postmenopausal Women: A Systematic Review.Current osteoporosis reports · 2015Pooled it
- Weaker subchondral bone and thinner articular cartilage of the knee are associated with elevated baseline fracture risk independently of osteoarthritis risk factors.Archives of osteoporosis · 2025Article
- FRAX: re-adjust or re-think.Archives of osteoporosis · 2020Review
- Prediction of major osteoporotic and hip fractures in Australian men using FRAX scores adjusted with trabecular bone score.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2018Article
- Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology.Bone reports · 2017Review
- Fracture prediction from repeat BMD measurements in clinical practice.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2016Article
- What Do We Know about Individuals Who Are Assessed as Being at Moderate Risk for Future Fracture in Canada?Health · 2015Article
- Bone: Which model to predict fracture risk?Nature reviews. Endocrinology · 2014Article
- Overview of Fracture Prediction Tools.Journal of clinical densitometry : the official journal of the International Society for Clinical DensitometryReview
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7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
unlabelledWe investigated the fracture risk assessment tool (FRAX) Canada calibration and discrimination according to income quintile in 51,327 Canadian women, with and without a competing mortality framework. Our data show that, under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of socioeconomic status (SES).
introductionFRAX® predicts 10-year fracture risk. Social factors may independently affect fracture risk. We investigated FRAX calibration and discrimination according to SES.
methodsWomen aged ≥50 years with baseline femoral neck bone mineral density (BMD) were identified from the Manitoba Bone Density Program, Canada (n = 51,327), 1996-2011. Mean household income, extracted from 2006 census files, was categorized into quintiles. Ten-year fracture probabilities were calculated using FRAX Canada. Incident non-traumatic fractures were studied in relation to income quintile in adjusted Cox proportional hazards models. We compared observed versus predicted fractures with and without a competing mortality framework.
resultsDuring mean 6.2 ± 3.7 years of follow up, there were 6,392 deaths, 3,723 women with ≥1 major osteoporotic fracture (MOF), and 1,027 with hip fractures. Lower income was associated with higher risk for death, MOF, and hip fracture in adjusted models (all p < 0.005). More women in income quintile 1 (lowest) versus quintile 5 experienced death (19 vs. 8%), MOF (10 vs. 6%), or hip fracture (3.0 vs. 1.3 %) (all p ≤ 0.001). Adjustment for competing mortality mitigated the effect of SES on FRAX calibration, and good calibration was observed. FRAX provided good fracture discrimination for MOF and hip fracture within each income quintile (all p < 0.001). Area under the curve was slightly lower for income quintiles 1 versus 5 for FRAX with BMD to predict MOF (0.68, 95% CI 0.66-0.70 vs. 0.71, 95% CI 0.69-0.74) and hip fracture (0.79, 95% CI 0.76-0.81 vs. 0.87, 95% CI 0.84-0.89).
conclusionIncreased fracture risk in individuals of lower income is offset by increased mortality. Under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of SES.
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