Table 3.
Summary of studies comparing fracture risk assessment between BMD and bone strength
| Study by fracture site | Demographic N fracture/no-fracture, sex (N = 5514 total) | Age-adjusted HR (per SD) or OR (95% CI) | ||
|---|---|---|---|---|
| BMD | Bone strength | |||
| Vertebral fracture (BCT/DXA measurements made at the spine): | ||||
| Melton 2007 [62]† | 40/40 | F | 0.7 (0.4–1.2) | 2.2 (1.2–4.3) |
| Melton 2010 [63]† | 193/90 | F | 1.3 (1.1–1.6) | 1.7 (1.4–2.1) |
| Wang 2012 [33] | 63/243 | M | 3.2 (2.0–5.2) | 7.2 (3.6–14.1) |
| Anderson 2014 [64]† | 40/80 | F/M | 1.9 (1.1–3.3) | 3.0 (1.4–6.9) |
| Kopperdahl 2014 [35] | 117/380 | F | 2.3 (1.7–3.2)†† | 2.8 (1.8–4.3) |
| 50/296 | M | 1.7 (1.2–2.5)†† | 2.2 (1.5–3.2) | |
| Allaire 2018 [34] | 26/62 | F/M | 1.8 (1.0–3.3) | 3.8 (1.5–9.2) |
| Hip fracture (BCT/DXA measurements made at the hip): | ||||
| Orwoll 2009 [16] | 40/210 | M | 4.6 (2.6–8.3) | 8.0 (2.6–24.3) |
| Kopperdahl 2014 [35] | 108/500 | F | 2.7 (1.9–3.9) | 4.2 (2.6–6.9) |
| 63/377 | M | 3.7 (2.5–5.6) | 3.5 (2.3–5.3) | |
| Adams 2018 [20]§ | 595/769 | F | 2.3 (1.9–2.9) | 3.6 (2.8–4.6) |
| 308/404 | M | 2.4 (1.9–3.1) | 3.0 (2.2–4.3) | |
| Any major osteoporotic fracture (BCT/DXA measurements made at the hip): | ||||
| Amin 2011 [76]† | 55/175 | F | 1.5 (1.1–1.9) | 1.8 (1.1–2.9) |
| 28/162 | M | 2.0 (1.3–3.0) | 3.2 (1.7–6.2) | |
Incident (new) fractures unless noted otherwise; BMD is measured by DXA (or is DXA-equivalent) unless noted otherwise; bone strength is measured by VirtuOst or earlier implementations
F female, M male
†Prevalent (existing) fracture (occurred before the imaging)
††Vertebral trabecular volumetric BMD by quantitative CT (spine BMD by DXA not measured in those studies)
§Results are reported here for patients not recently treated with any osteoporosis medication