SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019
Performance of predictive tools to identify individuals at risk of non-traumatic fracture: a systematic review, meta-analysis, and meta-regression.
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, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 5 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
57 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Forearm BMD predicts fracture independently of 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
- Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Guideline
- Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians.Annals of internal medicine · 2023Guideline
- Efficacy and safety of Romosozumab in treatment for low bone mineral density: a systematic review and meta-analysis.Clinical rheumatology · 2020Pooled it
- Fracture Risk Stratification by REMS: A 5 Years Prospective Longitudinal Multicentre Study.Calcified tissue international · 2026Observational
- Changes in treatment eligibility with race-neutral US FRAX would be modest: estimates using the National Health and Nutrition Examination Survey (NHANES).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Barriers and solutions for global access to osteoporosis management: a Position Paper from the International Osteoporosis Foundation.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Review
- Comparison of the time-dependent discriminatory accuracy of femoral strength and bone mineral density for predicting future hip and major osteoporotic fractures: a 16-year follow-up of the AGES-Reykjavik cohort.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Hip Fractures: Clinical, Biomaterial and Biomechanical Insights into a Common Health Challenge.Bioengineering (Basel, Switzerland) · 2025Review
- Identification of needs for an assistive robotic arm in individuals with tetraplegia: a mixed-methods approach.Journal of neuroengineering and rehabilitation · 2025Article
- 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
- Biomechanical perspectives on image-based hip fracture risk assessment: advances and challenges.Frontiers in endocrinology · 2025Review
- SNPs in GPCR Genes and Impaired Osteogenic Potency in Osteoporotic Patient Lines-Based Study.International journal of molecular sciences · 2024Article
- Osteoporosis in men-East and West: Can the twain meet? A perspective from Asia.Osteoporosis and sarcopenia · 2024Review
- 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
- Fracture risk assessment in the presence of competing risk of death.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Discriminatory Accuracy of Fracture Risk Assessment Tool in Asian Populations: A Systematic Review and Meta-Analysis.Journal of bone metabolism · 2024Article
- Hip Fracture Risk Assessment Tools for Adults Aged 80 Years and Older.JAMA network open · 2024Article
- Fracture risk prediction in postmenopausal women from GO Study: the comparison between FRAX, Garvan, and POL-RISK algorithms.Archives of osteoporosis · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There is no consensus on which tool is the most accurate to assess fracture risk. The results of this systematic review suggest that QFracture, Fracture Risk Assessment Tool (FRAX) with BMD, and Garvan with BMD are the tools with the best discriminative ability. More studies assessing the comparative performance of current tools are needed.
introductionMany tools exist to assess fracture risk. This review aims to determine which tools have the best predictive accuracy to identify individuals at high risk of non-traumatic fracture.
methodsStudies assessing the accuracy of tools for prediction of fracture were searched in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Global Health. Studies were eligible if discrimination was assessed in a population independent of the derivation cohort. Meta-analyses and meta-regressions were performed on areas under the ROC curve (AUCs). Gender, mean age, age range, and study quality were used as adjustment variables.
resultsWe identified 53 validation studies assessing the discriminative ability of 14 tools. Given the small number of studies on some tools, only FRAX, Garvan, and QFracture were compared using meta-regression models. In the unadjusted analyses, QFracture had the best discriminative ability to predict hip fracture (AUC = 0.88). In the adjusted analysis, FRAX with BMD (AUC = 0.81) and Garvan with BMD (AUC = 0.79) had the highest AUCs. For prediction of major osteoporotic fracture, QFracture had the best discriminative ability (AUC = 0.77). For prediction of osteoporotic or any fracture, FRAX with BMD and Garvan with BMD had higher discriminative ability than their versions without BMD (FRAX: AUC = 0.72 vs 0.69, Garvan: AUC = 0.72 vs 0.65). A significant amount of heterogeneity was present in the analyses.
conclusionsQFracture, FRAX with BMD, and Garvan with BMD have the highest discriminative performance for predicting fracture. Additional studies in which the performance of current tools is assessed in the same individuals may be performed to confirm this conclusion.
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