ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025
Effect of FRAXplus adjustments on fracture risk reclassification in older Swedish women-results from the SUPERB-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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Artificial intelligence in osteoporosis screening and fracture risk prediction among aging populations: a bibliometric evidence map.Frontiers in endocrinology · 2026Pooled it
- The phenotype of pelvic and acetabular fractures in adults aged 50 and older: a national database analysis in the Netherlands.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Impact of FRAXplus adjustments vs FRAX on fracture risk classification in the Swiss Osteoporosis Registry.JBMR plus · 2026Article
- Bone Mineral Density Loss After Kidney Transplantation: Metabolic Determinants, Diagnostic Approaches, and Preventive Strategies.Kidney international reports · 2026Review
- HALP score-adjusted FRAXplus tool effectively predicts hip fracture risk in elderly women with type 2 diabetes mellitus.BMC endocrine disorders · 2026Article
- Future Directions in Hypercalcemic and Normocalcemic Primary Hyperparathyroidism: FRAXplus for 10-Year Fracture Risk Assessment (A Retrospective Study).Life (Basel, Switzerland) · 2026Article
- Adjusting fracture probability according to duration of diabetes: the Manitoba BMD Registry.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Complementary effects of trabecular bone score and hip axis length on fracture risk: the Manitoba BMD Registry.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
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11 authors.
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Abstract
FRAXplus® facilitates adjustment of FRAX® fracture probabilities for additional clinical risk factors. This study examined how FRAXplus adjustments affect the proportion of older Swedish women eligible for treatment at a major osteoporotic fracture (MOF) probability intervention threshold (IT) ≥ 26%.
backgroundFRAXplus enables adjustments based on additional clinical information, such as recency of osteoporotic fractures, high-dose oral glucocorticoids, T2DM duration, lumbar spine (LS) bone mineral density (BMD), trabecular bone score (TBS), falls in the previous year, and hip axis length. We aimed to determine how these adjustments alter treatment eligibility in older Swedish women.
methodsTen-year fracture probabilities with femoral neck BMD were calculated using FRAX and adjusted by FRAXplus in the SUPERB cohort of 3028 Swedish women aged 75 to 80 years. Clinical risk factors (CRFs) and outcomes were collected via questionnaires and national registers over 8 years, with incident X-ray-verified MOFs. FRAXplus adjustments were applied one factor at a time; if multiple were available, the most influential factor was used. Net reclassification improvement (NRI) was calculated.
resultsOverall, 90% (n = 2723) had their 10-year MOF probability adjusted upwards, with a mean (± SD) change of 4.25% (5.12%). Common adjustments included HAL (31%), TBS (23%), falls (20%), LS BMD (8%), and recent fracture (5%). Similar patterns were observed for hip fracture probabilities. Among those below the IT using FRAX alone, 1785 remained below, with 365 (20.4%) experiencing incident MOFs. Of 339 women uplifted above the IT using FRAXplus, 119 (35.1%) sustained incident MOFs. Among 904 above the IT with both FRAX and FRAXplus, 324 (35.8%) experienced incident MOFs. The NRI was 4.82% (95% CI: 1.87-7.77%; p < 0.01).
conclusionsFRAXplus improved risk stratification, with a significant proportion of older Swedish women having their fracture probabilities uplifted above the IT, more accurately reflecting their elevated fracture risk, thereby enhancing the utility of risk assessment tools and improving patient management.
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