ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2021
Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study.
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, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Recommendations on screening for primary prevention of fragility fractures.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Guideline
- Pooled it
- Ten-year re-validation of the fracture risk assessment tool (FRAX®) in Taiwan.Archives of osteoporosis · 2026Article
- Application of machine learning in osteoporosis screening: a narrative review.NPJ digital medicine · 2026Review
- Approach to osteoporosis diagnosis and fracture risk management in primary care.Canadian family physician Medecin de famille canadien · 2026Review
- Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture.Skeletal radiology · 2024Review
- Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- Women's perspectives regarding osteoporosis, fracture risk, and pharmacologic treatment: a cross-sectional study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Conversion of measured bone mineral density T-scores of Chinese women to equivalent Caucasian women's T-score values.Quantitative imaging in medicine and surgery · 2023Article
- Osteoporosis and Fracture Risk among Older US Asian Adults.Current osteoporosis reports · 2023Review
- Article
- Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022Article
- Fracture risk in Asian-Canadian women is significantly over-estimated by the Canadian Association of Radiologists-Osteoporosis Canada risk prediction tool: retrospective cohort study.Archives of osteoporosis · 2022Article
- Concerns about Race and Ethnicity within the United States Fracture Risk Assessment Tool.Journal of bone metabolism · 2022Article
- Fine-tuning the cutpoint T-score as an epidemiological index with high specificity for osteoporosis: methodological considerations for the Chinese population.Quantitative imaging in medicine and surgery · 2022Article
- Fragility fracture prevalence among elderly Chinese is no more than half of that of elderly Caucasians.Quantitative imaging in medicine and surgery · 2022Article
- Establishment of a preliminary FRAX®-based intervention threshold for rheumatoid arthritis-associated fragility fracture: a 3-year longitudinal, observational, cohort study.Therapeutic advances in chronic disease · 2022Article
- Much lower prevalence and severity of radiographic osteoporotic vertebral fracture in elderly Hong Kong Chinese women than in age-matched Rome Caucasian women: a cross-sectional study.Archives of osteoporosis · 2021Article
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Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
Abstract
We identified large between-ethnicity calibration differences in the Canadian FRAX® tool which substantially overestimated the major osteoporotic fracture (MOF) risk in Asian women and Black women, and overestimated hip fracture risk in Asian women. PURPOSE: FRAX® is calibrated using population-specific fracture and mortality data. The need for FRAX to accommodate ethnic diversity within a country is uncertain. We addressed this question using the population-based Manitoba Bone Mineral Density (BMD) Program registry and self-reported ethnicity.
methodsThe study population was women aged 40 years or older with baseline FRAX assessments (Canadian and other ethnic calculators), fracture outcomes, and self-reported ethnicity (White N = 68,907 [referent], Asian N = 1910, Black N = 356). Adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to MOF and hip fracture were estimated. We examined candidate variables from DXA that might contribute to ethnic differences including skeletal size, hip axis length (HAL), trabecular bone score (TBS), and estimated body composition.
resultsAdjusted for baseline risk using the Canadian FRAX tool with BMD, Asian women compared with White women were at much lower risk for MOF (HR 0.46, 95% CI 0.35-0.59) and hip fracture (0.16, 95% CI 0.08-0.34). Black women were also at lower MOF risk (HR 0.58, 95% CI 0.32-1.00); there were no hip fractures. The US ethnic-specific FRAX calculators accounted for most of the between-ethnicity differences in MOF risk (86% for Asian, 92% for Black) but only partially accounted for lower hip fracture risk in Asian women (40%). The candidate variables explained only a minority of the effect of ethnicity. Gradient of risk in analyses was similar (p-interactions ethnicity*FRAX non-significant).
conclusionsWe identified significant ethnic differences in performance of the Canadian FRAX tool with fracture probability overestimated among Asian and Black women. The US ethnic calculators helped to address this discrepancy for MOF risk assessment, but not for hip fracture risk among Asian women.
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