ArticleBMJ open2018
Does bone mineral density improve the predictive accuracy of fracture risk assessment? A prospective cohort study in Northern Denmark.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Bone mineral content among Inuit - a systematic review of data.International journal of circumpolar health · 2025Pooled it
- Systemic Inflammation in Hip Fracture and Osteoarthritis: Insights into Pathways of Immunoporosis.International journal of molecular sciences · 2025Article
- Development and validation of common data model-based fracture prediction model using machine learning algorithm.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Screening for primary prevention of fragility fractures: How much time does it take?Canadian family physician Medecin de famille canadien · 2023Article
- Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX.Archives of osteoporosis · 2023Article
- Quantitative ultrasound assessment of the effect of parity on bone mineral density in females.BMC women's health · 2021Article
- FRAX score with and without bone mineral density: a comparison and factors affecting the discordance in osteoporosis treatment in Thais.Archives of osteoporosis · 2021Article
- Utility of fragility fracture prediction tools in a group of postmenopausal women.Reumatologia · 2021Article
- New Developments in Fracture Risk Assessment for Current Osteoporosis Reports.Current osteoporosis reports · 2020Review
- Bone Turnover Markers and Bone Mineral Density to Predict Osteoporotic Fractures in Older Women: A Retrospective Comparative Study.Orthopaedic surgery · 2020Article
- Nasal Administration and Plasma Pharmacokinetics of Parathyroid Hormone Peptide PTH 1-34 for the Treatment of Osteoporosis.Pharmaceutics · 2019Article
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5 authors.
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Abstract
objectiveTo evaluate the added predictive accuracy of bone mineral density (BMD) to fracture risk assessment.
designProspective cohort study using data between 01 January 2010 and 31 December 2012.
settingNorth Denmark Osteoporosis Clinic of referred patients presenting with at least one fracture risk factor to the referring doctor.
participantsPatients aged 40-90 years; had BMD T-score recorded at the hip and not taking osteoporotic preventing drugs for more than 1 year prior to baseline.
main outcome measuresIncident diagnoses of osteoporotic fractures (hip, spine, forearm, humerus and pelvis) were identified using the National Patient Registry of Denmark during 01 January 2012-01 January 2014. Cox regression was used to develop a fracture model based on predictors in the Fracture Risk Assessment Tool (FRAX®), with and without, binary and continuous BMD. Change in Harrell's C-Index and Reclassification tables were used to describe the added statistical value of BMD.
resultsAdjusting for predictors included in FRAX®, patients with osteoporosis (T-score ≤-2.5) had 75% higher hazard of a fracture compared with patients with higher BMD (HR: 1.75 (95% CI 1.28 to 2.38)). Forty per cent lower hazard was found per unit increase in continuous BMD T-score (HR: 0.60 (95% CI 0.52 to 0.69)).Accuracy improved marginally, and Harrell's C-Index increased by 1.2% when adding continuous BMD (0.76 to 0.77). Reclassification tables showed continuous BMD shifted 529 patients into different risk categories; 292 of these were reclassified correctly (57%; 95% CI 55% to 64%). Adding binary BMD however no improvement: Harrell's C-Index decreased by 0.6%.
conclusionsContinuous BMD marginally improves fracture risk assessment. Importantly, this was only found when using continuous BMD measurement for osteoporosis. It is suggested that future focus should be on evaluation of this risk factor using routinely collected data and on the development of more clinically relevant methodology to assess the added value of a new risk factor.
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