Related Experiment Video
Updated: Aug 6, 2025
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX
Lan Yang1, Mary Dempsey2, Attracta Brennan3
1Insight SFI Research Centre for Data Analytics, Data Science Institute, University of Galway, IDA Business Park, Lower Dangan, Galway, H91 AEX4, Ireland. lan.yang@universityofgalway.ie.
Abstract:
Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients.
Purpose:
FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD.
Method:
A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results.
Results:
Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases.
Conclusions:
Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.
Insights
FRAX fracture risk assessments using bone mineral density (BMD) show significant differences in individual patient results compared to assessments without BMD. Clinicians should carefully consider BMD inclusion for accurate fracture risk estimation.
Area of Science:
- Osteoporosis research
- Clinical decision support tools
- Biostatistics
Background:
- FRAX is a validated tool for estimating 10-year osteoporotic fracture risk.
- Previous studies suggested FRAX performs similarly with or without bone mineral density (BMD).
- DXA scans are a common method for assessing BMD.
Purpose of the Study:
- To compare FRAX fracture risk estimations with and without BMD inclusion.
- To evaluate within-subject differences between DXA-derived and Web-based FRAX calculations.
- To assess the impact of BMD on individual fracture risk assessments.
Main Methods:
- Cross-sectional study of 1254 adults aged 40-90 years with DXA scans.
- FRAX risk scores calculated using DXA software and a Web tool, both with and without BMD.
- Bland-Altman plots used to analyze agreement between estimates within subjects.
Main Results:
- Median FRAX scores including BMD were similar between DXA and Web tools.
- FRAX scores were significantly lower when BMD was included compared to when it was excluded.
- Substantial within-subject differences (>6% for hip, >10% for major osteoporotic fracture) were observed in a notable proportion of individuals when BMD was excluded.
Conclusions:
- Excellent agreement exists between DXA-FRAX and Web-FRAX when BMD is incorporated.
- Significant individual variations in fracture risk estimates occur depending on BMD inclusion.
- Clinicians must carefully consider BMD's role in FRAX assessments for personalized patient care.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:10X-ray Diffraction of Biological Samples
According to Bragg's law, when X-rays strike the sample positioned on a stage, the rays are scattered by the electron clouds around the sample atoms. The X-ray diffraction or scattering is caused by constructive interference of the X-ray waves that reflect off the internal...
02:18X-ray Crystallography
Diffraction
Diffraction is the change in the direction of travel experienced by an electromagnetic wave when it encounters a physical barrier whose dimensions are comparable to those of the wavelength of the light. X-rays are electromagnetic radiation with wavelengths about as long as the distance between neighboring...