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However, an understanding of ethnic differences in such bone strength measurements between Whites and Asians is lacking, which is an obstacle to clinical interpretation. Using previously taken CT and DXA scans, we analyzed bone strength and bone mineral density (BMD) at the hip and spine in two sex- and age-matched community-based cohorts, aged 40 to 80\u2009years: Whites (Rochester, MN, USA) and Koreans (Seoul, South Korea). For both the spine and femur, the age dependence of bone strength was similar for both groups, White (n = 371; women n = 202, 54.5%) and Korean (n = 396; women n = 199, 50.3%). For both sexes, mean spine strength did not differ between groups, but femur strength was 9% to 14% higher in Whites (p\u2009\u2264\u20090.001), an effect that became non-significant after weight adjustment (p = 0.375). For Koreans of both sexes, the fragile bone strength thresholds for classifying osteoporosis, when derived from regional DXA BMD T-score references, equaled the clinically validated thresholds for Whites (in women and men, femoral strength, 3000\u2009N and 3500\u2009N; vertebral strength 4500\u2009N and 6500\u2009N, respectively). Using these thresholds, classifications for osteoporosis for Koreans based on bone strength versus based on DXA BMD T-scores were consistent (89.1% to 94.4% agreement) at both the hip and spine and for both sexes. The BCT-based, clinically validated bone strength thresholds for Whites also applied to Koreans, which may facilitate clinical interpretation of CT-based bone strength measurements for Koreans. \u00a9 2020 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4149","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T20:04:36Z","timestamp":1596571476000},"page":"2345-2354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Comparison of Vertebral and Femoral Strength Between White and Asian Adults Using Finite Element Analysis of Computed Tomography Scans"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8246-1956","authenticated-orcid":false,"given":"Namki","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Endocrine Research Institute, Severance Hospital Yonsei University College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C","family":"Lee","sequence":"additional","affiliation":[{"name":"O.N. Diagnostics Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2936-4372","authenticated-orcid":false,"given":"Sundeep","family":"Khosla","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony M","family":"Keaveny","sequence":"additional","affiliation":[{"name":"Departments of Mechanical Engineering and Bioengineering University of California Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4227-5638","authenticated-orcid":false,"given":"Yumie","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Endocrine Research Institute, Severance Hospital Yonsei University College of Medicine Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,4]]},"reference":[{"key":"2024031419000929800_jbmr4149-bib-0001","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.bone.2017.01.024","article-title":"The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide","volume":"104","author":"Curtis","year":"2017","journal-title":"Bone."},{"issue":"9995","key":"2024031419000929800_jbmr4149-bib-0002","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/S0140-6736(15)60692-4","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"386","author":"Global Burden of Disease Study 2013 Collaborators","year":"2015","journal-title":"Lancet"},{"key":"2024031419000929800_jbmr4149-bib-0003","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1007\/s11657-013-0136-1","article-title":"Osteoporosis in the European Union: medical management, epidemiology and economic burden. 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