SynthesisJournal of endocrinological investigation2023
A systematic review on the performance of fracture risk assessment tools: FRAX, DeFRA, FRA-HS.
Synthesis in Journal of endocrinological investigation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- 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
- Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials.Journal of endocrinological investigation · 2024Pooled it
- Fracture Risk Stratification by REMS: A 5 Years Prospective Longitudinal Multicentre Study.Calcified tissue international · 2026Observational
- Estimating the Extent of Missed Opportunities for Osteoporosis Treatment Before Hip Fracture Occurrence.Calcified tissue international · 2026Article
- Clinical characteristics of the reduced bone mineral density subgroup among adults with type 2 diabetes mellitus: a retrospective cross-sectional study.BMC musculoskeletal disorders · 2026Article
- Ten-year re-validation of the fracture risk assessment tool (FRAX®) in Taiwan.Archives of osteoporosis · 2026Article
- Under-recognized, under-referred: a multidisciplinary evaluation of fragility fracture management in the emergency setting.Archives of osteoporosis · 2026Article
- Current clinical practices in osteoporosis management across Italy: a survey analysis and expert opinion.Archives of osteoporosis · 2026Article
- Real-world effectiveness of denosumab compared to teriparatide in patients with severe osteoporosis.Frontiers in endocrinology · 2026Article
- ROMosozumab early experience in female patients with severe osteoporosis in an Italian real-world setting, the ROMEO study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Safety of Romosozumab in women with cancer and osteoporosis at high risk of fractures.Endocrine · 2025Observational
- The Association of Bone-related Biomarkers With Incident Hip Fracture: A Nested Case-control Study.Journal of the Endocrine Society · 2025Article
- Bayesian Genome-wide Polygenic Score Integration with FRAX for Enhanced Fracture Risk Prediction in Postmenopausal Women.medRxiv : the preprint server for health sciences · 2025Article
- Early administration of romosozumab prevents rebound of bone resorption related to denosumab withdrawal in fractured post-menopausal women: a real-world prospective study.Journal of endocrinological investigation · 2025Article
- Assessment of the 10-Year Probability of Fracture Using Femoral Neck (FRAX) and Lumbar BMD (FRAXplus) in Menopausal Women with Non-Functioning Adrenal Tumors: Where We Stand Today (A Study-Focused Analysis).Journal of clinical medicine · 2025Article
- Osteoporosis in Men: an Overlooked Patient Population.Current osteoporosis reports · 2025Review
- [Diagnostics and classification of fractures of the thoracic and lumbar spine in adults : Approach depending on the bone structure].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- The use of the FRAX® tool and its adjustments in women living with diabetes: a cohort study in primary care in Brazil.Archives of osteoporosis · 2024Article
- A practical approach for anabolic treatment of bone fragility with romosozumab.Journal of endocrinological investigation · 2024Review
Corrections and comments
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Authors and funding
24 authors.
Funding
Abstract
purposePreventing fragility fractures by treating osteoporosis may reduce disability and mortality worldwide. Algorithms combining clinical risk factors with bone mineral density have been developed to better estimate fracture risk and possible treatment thresholds. This systematic review supported panel members of the Italian Fragility Fracture Guidelines in recommending the use of best-performant tool. The clinical performance of the three most used fracture risk assessment tools (DeFRA, FRAX, and FRA-HS) was assessed in at-risk patients.
methodsPubMed, Embase, and Cochrane Library were searched till December 2020 for studies investigating risk assessment tools for predicting major osteoporotic or hip fractures in patients with osteoporosis or fragility fractures. Sensitivity (Sn), specificity (Sp), and areas under the curve (AUCs) were evaluated for all tools at different thresholds. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2; certainty of evidence (CoE) was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
resultsForty-three articles were considered (40, 1, and 2 for FRAX, FRA-HS, and DeFRA, respectively), with the CoE ranging from very low to high quality. A reduction of Sn and increase of Sp for major osteoporotic fractures were observed among women and the entire population with cut-off augmentation. No significant differences were found on comparing FRAX to DeFRA in women (AUC 59-88% vs. 74%) and diabetics (AUC 73% vs. 89%). FRAX demonstrated non-significantly better discriminatory power than FRA-HS among men.
conclusionThe task force formulated appropriate recommendations on the use of any fracture risk assessment tools in patients with or at risk of fragility fractures, since no statistically significant differences emerged across different prediction tools.
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