The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women

J. A. Kanis, A. Oden, O. Johnell, H. Johansson, C. De Laet, J. Brown, P. Burckhardt, C. Cooper, C. Christiansen, S. Cummings, J. A. Eisman, S. Fujiwara, C. Glüer, D. Goltzman, D. Hans, M. A. Krieg, A. La Croix, E. McCloskey, D. Mellstrom, L. J. MeltonH. Pols, J. Reeve, K. Sanders, A. M. Schott, A. Silman, D. Torgerson, T. Van Staa, N. B. Watts, N. Yoshimura

Research output: Contribution to journalArticlepeer-review


Summary: BMD and clinical risk factors predict hip and other osteoporotic fractures. The combination of clinical risk factors and BMD provide higher specificity and sensitivity than either alone. Introduction and hypotheses: To develop a risk assessment tool based on clinical risk factors (CRFs) with and without BMD. Methods: Nine population-based studies were studied in which BMD and CRFs were documented at baseline. Poisson regression models were developed for hip fracture and other osteoporotic fractures, with and without hip BMD. Fracture risk was expressed as gradient of risk (GR, risk ratio/SD change in risk score). Results: CRFs alone predicted hip fracture with a GR of 2.1/SD at the age of 50 years and decreased with age. The use of BMD alone provided a higher GR (3.7/SD), and was improved further with the combined use of CRFs and BMD (4.2/SD). For other osteoporotic fractures, the GRs were lower than for hip fracture. The GR with CRFs alone was 1.4/SD at the age of 50 years, similar to that provided by BMD (GR=1.4/SD) and was not markedly increased by the combination (GR=1.4/SD). The performance characteristics of clinical risk factors with and without BMD were validated in eleven independent population-based cohorts. Conclusions: The models developed provide the basis for the integrated use of validated clinical risk factors in men and women to aid in fracture risk prediction. © 2007 International Osteoporosis Foundation and National Osteoporosis Foundation.
Original languageEnglish
Pages (from-to)1033-1046
Number of pages13
JournalOsteoporosis International
Issue number8
Publication statusPublished - Aug 2007


  • Bone mineral density
  • Hip fracture
  • Meta-analysis
  • Osteoporotic fracture
  • Risk assessment


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