Impact of Femoral Neck and Lumbar Spine BMD Discordances on FRAX Probabilities in Women: A Meta-analysis of International Cohorts

H. Johansson, J. A. Kanis, A. Oden, W. D. Leslie, S. Fujiwara, C. C. Gluer, H. Kroger, A. Z. LaCroix, E. Lau, L. J. Melton, J. A. Eisman, T. W. O'Neill, D. Goltzman, D. M. Reid, E. McCloskey*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)


There are occasional marked discordances in BMD T-scores at the lumbar spine (LS) and femoral neck (FN). We investigated whether such discordances could contribute independently to fracture prediction using FRAX. We studied 21,158 women, average age 63 years, from 10 prospective cohorts with baseline FRAX variables as well as FN and LS BMD. Incident fractures were collected by self-report and/or radiographic reports. Extended Poisson regression examined the relationship between differences in LS and FN T-scores (Delta LS-FN) and fracture risk, adjusted for age, time since baseline and other factors including FRAX 10-year probability for major osteoporotic fracture calculated using FN BMD. To examine the effect of an adjustment for Delta LS-FN on reclassification, women were separated into risk categories by their FRAX major fracture probability. High risk was classified using two approaches: being above the National Osteoporosis Guideline Group intervention threshold or, separately, being in the highest third of each cohort. The absolute Delta LS-FN was greater than 2 SD for 2.5 % of women and between 1 and 2 SD for 21 %. Delta LS-FN was associated with a significant risk of fracture adjusted for baseline FRAX (HR per SD change = 1.09; 95 % CI = 1.04-1.15). In reclassification analyses, only 2.3-3.2 % of the women moved to a higher or lower risk category when using FRAX with Delta LS-FN compared with FN-derived FRAX alone. Adjustment of estimated fracture risk for a large LS/FN discrepancy (> 2SD) impacts to a large extent on only a relatively small number of individuals. More moderate (1-2SD) discordances in FN and LS T-scores have a small impact on FRAX probabilities. This might still improve clinical decision-making, particularly in women with probabilities close to an intervention threshold.

Original languageEnglish
Pages (from-to)428-435
Number of pages8
JournalCalcified Tissue International
Issue number5
Early online date4 Sept 2014
Publication statusPublished - Nov 2014

Bibliographical note

Date of Acceptance: 14/08/2015

Acknowledgments The Rochester study was supported by the National Institute of Musculoskeletal and Skin Diseases (R01 AR27065), U.S. Public Health Service. The AHS has been conducting at the Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan, which is a private, non-profit foundation funded by the Japanese Ministry of Health, Labour and Welfare (MHLW) and the U.S. Department of Energy (DOE), the latter in part through DOE Award DE-HS0000031 to the National Academy of Sciences. CaMos is currently funded by the Canadian Institutes for Health Research (CIHR), with additional support from Amgen, Merck Frosst Canada Ltd, and Eli Lilly and Company. The OSTPRE study was supported by the Academy of Finland. The Women’s Health Initiative programme is funded by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the US Department of Health and Human Services. Mr OS (Hong Kong) is also supported by National Institutes of Health funding. The Dubbo Osteoporosis Epidemiology study has been supported by the National Health and Medical Research Council of Australia and by untied educational grants from Amgen, GE-LUNAR, Lilly, Merck Sharp and Dohme,Novartis, Sanofi-Aventis and Servier.


  • FRAX
  • BMD
  • discordance
  • reclassification
  • fracture risk
  • bone-mineral density
  • band ultrasound attenuation
  • fracture risk-assessment
  • osteoperotic fractures
  • postmenopausal women
  • vertebral deformity
  • multiple sites
  • US adults
  • men
  • prediction


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