Evidence map›Paper›PMID 38861422›Full record

Observational studyJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2024

Osteoporosis treatment prevents hip fracture similarly in both sexes: the FOCUS observational study.

Tony M Keaveny, Annette L Adams, Eric S Orwoll, Sundeep Khosla, Ethel S Siris, Michael R McClung, Mary L Bouxsein, Shireen Fatemi, David C Lee, David L Kopperdahl

Abstract readObservational Study
In one paragraph

Observational study in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Effectiveness of treatment initiation for secondary fracture prevention in the older population: Japanese Bone-fracture Osteoporosis in Late-stage population Database study (J-BOLD) - emulation of a randomized target trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Trial
  2. Trial
  3. Article
  4. Improved prediction of hip fracture using multi-faceted biomechanical computed tomography.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026
    Article
  5. Article
  6. Article
  7. Review
  8. New insights into bone mineral density for predicting hip fracture.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025
    Article
  9. Rationale for osteoporosis screening in men.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Tony M KeavenyDepartments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA 94720, United States.ORCID 0000-0003-0258-7178
Annette L AdamsDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, United States.ORCID 0000-0001-7338-4808
Eric S OrwollBone and Mineral Unit, Oregon Health & Science University, Portland, OR 97239, United States.ORCID 0000-0002-8520-7355
Sundeep KhoslaDivision of Endocrinology, Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States.ORCID 0000-0002-2936-4372
Ethel S SirisDepartment of Medicine, Toni Stabile Osteoporosis Center, Columbia University Medical Center, New York, NY 10032, United States.ORCID 0000-0002-9736-3451
Michael R McClungOregon Osteoporosis Center, Portland, OR 97225, United States.ORCID 0000-0002-7827-0778
Mary L BouxseinDepartment of Orthopedic Surgery, Harvard Medical School, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.ORCID 0000-0002-7027-7414
Shireen FatemiDepartment of Endocrinology, Kaiser Permanente Southern California, Panorama City, CA 91402, United States.
David C LeeO.N. Diagnostics LLC, Berkeley, CA 94704, United States.ORCID 0009-0006-4486-331X
David L KopperdahlO.N. Diagnostics LLC, Berkeley, CA 94704, United States.ORCID 0000-0001-6127-5145

Funding

Clinical Biomechanics of Hip FractureR01AR074958 · NIAMS · O. N. DIAGNOSTICS, LLC · PI KOPPERDAHL, DAVID · 2020 to 2022
$1.8M
NIAMS NIH HHS R01 AR074958NIH HHS R01 AR074958
6 · The paper itself

Abstract

Randomized trials have not been performed, and may never be, to determine if osteoporosis treatment prevents hip fracture in men. Addressing that evidence gap, we analyzed data from an observational study of new hip fractures in a large integrated healthcare system to compare the reduction in hip fractures associated with standard-of-care osteoporosis treatment in men versus women. Sampling from 271,389 patients aged ≥ 65 who had a hip-containing CT scan during care between 2005 and 2018, we selected all who subsequently had a first hip fracture (cases) after the CT scan (start of observation) and a sex-matched equal number of randomly selected patients. From those, we analyzed all who tested positive for osteoporosis (DXA-equivalent hip BMD T-score ≤ -2.5, measured from the CT scan using VirtuOst). We defined "treated" as at least six months of any osteoporosis medication by prescription fill data during follow-up; "not-treated" was no prescription fill. Sex-specific odds ratios of hip fracture for treated vs not-treated patients were calculated by logistic regression; adjustments included age, BMD T-score, BMD-treatment interaction, BMD, race/ethnicity, and seven baseline clinical risk factors. At two-year follow-up, 33.9% of the women (750/2,211 patients) and 24.0% of the men (175/728 patients) were treated primarily with alendronate; 51.3% and 66.3%, respectively, were not-treated; and 721 and 269, respectively, had a first hip fracture since the CT scan. Odds ratio of hip fracture for treated vs not-treated was 0.26 (95% confidence interval: 0.21-0.33) for women and 0.21 (0.13-0.34) for men; the ratio of these odds ratios (men:women) was 0.81 (0.47-1.37), indicating no significant sex effect. Various sensitivity and stratified analyses confirmed these trends, including results at five-year follow-up. Given these results and considering the relevant literature, we conclude that osteoporosis treatment prevents hip fracture similarly in both sexes.

Indexed as

Hip FracturesOsteoporosisAgedAged, 80 and overBone Density Conservation AgentsFemaleHumansMaleBone Density Conservation Agentsantiresorptivesfracture preventionfracture risk assessmentosteoporosisscreening

Identifiers

PMID38861422
PMCPMC11425693

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.