Background This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations.
Methods We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values. Meta-analyses were conducted after quality assessment for AUC with 95% confidence intervals across the following categories: standard FRAX without/with bone mineral density (BMD), adjusted FRAX, and BMD alone for fracture prediction, as well as standard FRAX for densitometric diagnosis of osteoporosis.
Results A total of 42 studies were included. The AUC values for predicting fracture risk using FRAX-MOF with BMD (0.73 [0.70–0.77]) was highest compared to FRAX-MOF without BMD (0.72 [0.66–0.77]), and adjusted FRAX-MOF (0.71 [0.65–0.77]). The AUC values for predicting fracture risk using FRAX-HF with BMD (0.77 [0.71–0.83]) was highest compared to FRAX-HF without BMD (0.72 [0.65–0.80]), and adjusted FRAX-HF (0.75 [0.63–0.86]). The AUC values for BMD alone (0.68 [0.62–0.73]) was lowest for fracture prediction. The AUC values for identifying a densitometric diagnosis of osteoporosis was 0.77 [0.70–0.84] and 0.76 [0.67-0.86] using FRAX-MOF and FRAX-HF, respectively.
Conclusions FRAX with BMD tends to perform more reliably in predicting HF compared to MOF in Asia. However, its accuracy in predicting fracture risk in Asian populations can be improved through region-specific, long-term epidemiological data.
Citations
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1. Health outcomes and care needs after osteoporotic fractures in rural Chinese older adults: policy implications Qian Zhu, Caixia Ran Frontiers in Public Health.2025;[Epub] CrossRef
2. Relationship between areal BMD, FRAX®, and femoral strength in community-dwelling older Asian adults Dheeraj Jha, Manju Chandran, Dario Koller, Vee San Cheong, Anitha D. Praveen, Alexander Baker, Preeti Gupta, Ecosse L. Lamoureux, Halldór Pálsson, Stephen J. Ferguson, Benedikt Helgason Archives of Osteoporosis.2025;[Epub] CrossRef
3. Development of a machine learning-based predictive model for osteoporosis risk and its application in clinical decision support Zichen Shao, Jianfeng Wu, Qinqin Deng, Ling Cheng, Xin Huang, Weikang Sun, Weidong Liang, Huanan Li Frontiers in Medicine.2025;[Epub] CrossRef
4. Dual-energy X-ray absorptiometry based biofidelic finite element models for simulating falls to the hip: Impact of trochanteric soft tissue thickness on fracture risk Dheeraj Jha, Anitha D. Praveen, Alexander Baker, Anita Fung, Vee San Cheong, Preeti Gupta, Ecosse L. Lamoureux, Namki Hong, Yumie Rhee, Vanessa Jean Wen Koh, Halldór Pálsson, William R. Taylor, Angelique Wei-Ming Chan, Stephen J. Ferguson, Benedikt Helgas Clinical Biomechanics.2025; : 106720. CrossRef
5. Osteoporosis in men—East and West: Can the twain meet? A perspective from Asia Gerald Gui Ren Sng, Jean-Yves Reginster, Majed S. Alokail, Manju Chandran Osteoporosis and Sarcopenia.2024; 10(4): 131. CrossRef
Background The coronavirus disease 2019 (COVID-19) pandemic and the consequent social distancing period are thought to have influenced the incidence of osteoporotic fracture in various ways, but the exact changes have not yet been well elucidated. The purpose of this study was to investigate the impact of the COVID-19 pandemic on the incidence of osteoporotic fracture using a nationwide cohort.
Methods The monthly incidence rates of vertebral; hip; and non-vertebral, non-hip fractures were collected from a nationwide database of the Korean National Health Insurance Review and Assessment from July 2016 to June 2021. Segmented regression models were used to assess the change in levels and trends in the monthly incidence of osteoporotic fractures.
Results There was a step decrease in the incidence of vertebral fractures for both males (6.181 per 100,000, P=0.002) and females (19.299 per 100,000, P=0.006). However, there was a negative trend in the incidence of hip fracture among both males (-0.023 per 100,000 per month, P=0.023) and females (-0.032 per 100,000 per month, P=0.019). No impact of COVID-19-related social distancing was noted.
Conclusions In conclusion, during the early days of the COVID-19 pandemic, vertebral fracture incidence considerably decreased with the implementation of social distancing measures.
Citations
Citations to this article as recorded by
1. Trends of incidence and 1-year mortality of vertebral fractures in Korea using nationwide claims data Young-Kyun Lee, Jung-Wee Park, Tae-Young Kim, Jihye Kim, Hoyeon Jang, Jaiyong Kim, Yong-Chan Ha Archives of Osteoporosis.2025;[Epub] CrossRef
2. Global, regional, and national burden of vertebral fractures among women from 1990 to 2021: a systematic analysis based on the global burden of disease study Junpeng Liu, Xingchen Yao, Zhiheng Zhao, Xinglin Liu, Sheyang Xu, Bowen Lu, Xianglong Meng European Spine Journal.2025;[Epub] CrossRef
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