ArticleRMD open2017
Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study.
Article in RMD open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 6 of them syntheses that pooled it.
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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.
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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
13 citing papers in PubMed, 6 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Predictive value of BMD for hip and other fractures: a meta-analysis to update FRAX.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Pooled 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
- Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022Pooled it
- Community-based evaluation of Saudi FRAX with and without BMD in Riyadh, Saudi Arabia.Archives of osteoporosis · 2025Article
- Evaluating the performance of the Charlson Comorbidity Index (CCI) in fracture risk prediction and developing a new Charlson Fracture Index (CFI): a register-based cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022Article
- Role of calcium and phosphorous concentration as an intrinsic factor in the development of skull fracture following road traffic accidents.Journal of family medicine and primary care · 2020Article
- Elevated Serum 25-Hydroxyvitamin D Levels Are Associated with Improved Bone Formation and Micro-Structural Measures in Elderly Hip Fracture Patients.Journal of clinical medicine · 2019Article
- Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study.Journal of clinical medicine · 2019Article
- New Insights Into Monogenic Causes of Osteoporosis.Frontiers in endocrinology · 2019Review
- Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark.BMJ open · 2018Article
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveEvaluate the performance of FRAX®, with and without bone mineral densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years.
methodsParticipants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from three cohorts (n=2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating characteristic analysis.
resultsDuring a mean (SD) follow-up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95% CI 0.72 to 0.79) for MOP fractures and 0.78 (95% CI 0.69 to 0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95% CI 0.74 to 0.82, p=0.25) or hip fractures (0.79, 95% CI 0.69 to 0.89, p=0.72). AUCs for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD, tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95% CI of the number predicted, both with and without BMD.
conclusionFRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.
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