ArticleBMJ (Clinical research ed.)2017
External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study.
Article in BMJ (Clinical research ed.), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 6 of them syntheses that pooled it.
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Who cites it
61 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Management of Osteoporosis in Parkinson's Disease: A Systematic Review of Clinical Practice Guidelines.Movement disorders clinical practice · 2025Pooled it
- Pooled it
- A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS.Journal of endocrinological investigation · 2023Pooled it
- Pooled it
- Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021.Frontiers in endocrinology · 2023Pooled it
- 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
- Artificial Intelligence for Perioperative Risk Prediction and Prevention in Cardiac Surgery: A Narrative Review and Proposed Conceptual Framework.Journal of clinical medicine · 2026Review
- Association of trabecular texture and paraspinal muscle characteristics with prevalent vertebral fractures - QCT results from a subcohort of the AGES population.BMC musculoskeletal disorders · 2026Article
- MMPro-HIP: multimodal progressive fusion model for elderly HIP fracture risk prediction.Frontiers in medicine · 2026Article
- Screening for Osteoporosis in Nonagenarians: A Scoping Review.Journal of the American Geriatrics Society · 2025Article
- Barriers to translating continuous monitoring technologies for preventative medicine.Nature biomedical engineering · 2025Review
- Predictive capacity of fracture risk assessment tools: overview of systematic reviews.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Review
- Hip Fractures: Clinical, Biomaterial and Biomechanical Insights into a Common Health Challenge.Bioengineering (Basel, Switzerland) · 2025Review
- Bone Health, Fragility Fractures, and the Hand Surgeon.Journal of hand surgery global online · 2025Review
- Biases in the performance of FRAX without BMD in predicting fracture risk in a multiethnic population with diabetes: the Diabetes and Aging Study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025Article
- A new cut-off value of FRAX tools as an osteoporosis screening tool for Thai geriatric population.Scientific reports · 2025Article
- Two-year follow-up study (PRIMROSE 3) to assess bone mineral density in subjects with uterine fibroids completing the PRIMROSE 1 and PRIMROSE 2 linzagolix trials.Human reproduction open · 2025Article
- An electronic health record (EHR)-based risk calculator can predict fractures comparably to FRAX: a proof-of-concept study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older.JAMA network open · 2024Article
1 more citing papers are in PubMed but not listed here.
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveTo directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures-QFracture, FRAX, and Garvan-using data from electronic health records.
designRetrospective cohort study.
settingPayer provider healthcare organisation in Israel.
participants1 054 815 members aged 50 to 90 years for comparison between tools and cohorts of different age ranges, corresponding to those in each tools' development study, for tool specific external validation.
main outcome measureFirst diagnosis of a major osteoporotic fracture (for QFracture and FRAX tools) and hip fractures (for all three tools) recorded in electronic health records from 2010 to 2014. Observed fracture rates were compared to probabilities predicted retrospectively as of 2010.
resultsThe observed five year hip fracture rate was 2.7% and the rate for major osteoporotic fractures was 7.7%. The areas under the receiver operating curve (AUC) for hip fracture prediction were 82.7% for QFracture, 81.5% for FRAX, and 77.8% for Garvan. For major osteoporotic fractures, AUCs were 71.2% for QFracture and 71.4% for FRAX. All the tools underestimated the fracture risk, but the average observed to predicted ratios and the calibration slopes of FRAX were closest to 1. Tool specific validation analyses yielded hip fracture prediction AUCs of 88.0% for QFracture (among those aged 30-100 years), 81.5% for FRAX (50-90 years), and 71.2% for Garvan (60-95 years).
conclusionsBoth QFracture and FRAX had high discriminatory power for hip fracture prediction, with QFracture performing slightly better. This performance gap was more pronounced in previous studies, likely because of broader age inclusion criteria for QFracture validations. The simpler FRAX performed almost as well as QFracture for hip fracture prediction, and may have advantages if some of the input data required for QFracture are not available. However, both tools require calibration before implementation.
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