{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:35:36Z","timestamp":1790919336607,"version":"4.1.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":409,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Friends of Hebrew SeniorLife in Boston, MA"},{"name":"Investigator Initiated Studies Program of Merck Sharp & Dohme"},{"name":"National Heart, Lung, and Blood Institute Framingham Heart Study","award":["N01-HC-25195"],"award-info":[{"award-number":["N01-HC-25195"]}]},{"name":"National Heart, Lung, and Blood Institute Framingham Heart Study","award":["HHSN268201500001I"],"award-info":[{"award-number":["HHSN268201500001I"]}]},{"name":"National Institute of Arthritis Musculoskeletal and Skin Diseases of the National Institutes of Health","award":["R01AR061445"],"award-info":[{"award-number":["R01AR061445"]}]},{"name":"National Institute of Arthritis Musculoskeletal and Skin Diseases of the National Institutes of Health","award":["AR027065"],"award-info":[{"award-number":["AR027065"]}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["364554"],"award-info":[{"award-number":["364554"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008459","name":"University of Calgary","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008459","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["364554"],"award-info":[{"award-number":["364554"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008459","name":"University of Calgary","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008459","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Prevalence of osteoporosis is more than 50% in older adults, yet current clinical methods for diagnosis that rely on areal bone mineral density (aBMD) fail to detect most individuals who have a fragility fracture. Bone fragility can manifest in different forms, and a \u201cone-size-fits-all\u201d approach to diagnosis and management of osteoporosis may not be suitable. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides additive information by capturing information about volumetric density and microarchitecture, but interpretation is challenging because of the complex interactions between the numerous properties measured. In this study, we propose that there are common combinations of bone properties, referred to as phenotypes, that are predisposed to different levels of fracture risk. Using HR-pQCT data from a multinational cohort (n\u00a0=\u00a05873, 71% female) between 40 and 96\u2009years of age, we employed fuzzy c-means clustering, an unsupervised machine-learning method, to identify phenotypes of bone microarchitecture. Three clusters were identified, and using partial correlation analysis of HR-pQCT parameters, we characterized the clusters as low density, low volume, and healthy bone phenotypes. Most males were associated with the healthy bone phenotype, whereas females were more often associated with the low volume or low density bone phenotypes. Each phenotype had a significantly different cumulative hazard of major osteoporotic fracture (MOF) and of any incident osteoporotic fracture (p\u2009&amp;lt;\u20090.05). After adjustment for covariates (cohort, sex, and age), the low density followed by the low volume phenotype had the highest association with MOF (hazard ratio\u00a0=\u00a02.96 and 2.35, respectively), and significant associations were maintained when additionally adjusted for femoral neck aBMD (hazard ratio\u00a0=\u00a01.69 and 1.90, respectively). Further, within each phenotype, different imaging biomarkers of fracture were identified. These findings suggest that osteoporotic fracture risk is associated with bone phenotypes that capture key features of bone deterioration that are not distinguishable by aBMD. \u00a9 2021 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4494","type":"journal-article","created":{"date-parts":[[2021,12,25]],"date-time":"2021-12-25T13:04:52Z","timestamp":1640437492000},"page":"428-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk"],"prefix":"10.1093","volume":"37","author":[{"given":"Danielle E","family":"Whittier","sequence":"first","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine University of Calgary Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1086-1560","authenticated-orcid":false,"given":"Elizabeth J","family":"Samelson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA"},{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew Senior Life Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9586-6928","authenticated-orcid":false,"given":"Marian T","family":"Hannan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA"},{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew Senior Life Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0348-5643","authenticated-orcid":false,"given":"Lauren A","family":"Burt","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine University of Calgary Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Hanley","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine University of Calgary Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6174-1951","authenticated-orcid":false,"given":"Emmanuel","family":"Biver","sequence":"additional","affiliation":[{"name":"Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine University of Geneva Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4168-6697","authenticated-orcid":false,"given":"Pawel","family":"Szulc","sequence":"additional","affiliation":[{"name":"INSERM UMR1033 Universit\u00e9 de Lyon, H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2573-5316","authenticated-orcid":false,"given":"Elisabeth","family":"Sornay-Rendu","sequence":"additional","affiliation":[{"name":"INSERM UMR1033 Universit\u00e9 de Lyon, H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandine","family":"Merle","sequence":"additional","affiliation":[{"name":"INSERM UMR1033 Universit\u00e9 de Lyon, H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8214-6385","authenticated-orcid":false,"given":"Roland","family":"Chapurlat","sequence":"additional","affiliation":[{"name":"INSERM UMR1033 Universit\u00e9 de Lyon, H\u00f4pital Edouard Herriot Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lespessailles","sequence":"additional","affiliation":[{"name":"EA 4708-I3MTO University of Orleans Orleans France"},{"name":"Regional Hospital of Orleans PRIMMO Orleans France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy Kin On","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Joint Department of Medical Imaging University Health Network Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3421-7147","authenticated-orcid":false,"given":"David","family":"Goltzman","sequence":"additional","affiliation":[{"name":"Department of Medicine McGill University and McGill University Health Centre Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2936-4372","authenticated-orcid":false,"given":"Sundeep","family":"Khosla","sequence":"additional","affiliation":[{"name":"Kogod Center on Aging and Division of Endocrinology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-4417","authenticated-orcid":false,"given":"Serge","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine University of Geneva Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-7414","authenticated-orcid":false,"given":"Mary L","family":"Bouxsein","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Harvard Medical School Boston MA USA"},{"name":"Endocrine Unit Massachusetts General Hospital Boston MA USA"},{"name":"Center for Advanced Orthopedic Studies BIDMC Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8474-0310","authenticated-orcid":false,"given":"Douglas P","family":"Kiel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA"},{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew Senior Life Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2930-5997","authenticated-orcid":false,"given":"Steven K","family":"Boyd","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine University of Calgary Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,25]]},"reference":[{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0001","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/jama.285.6.785","article-title":"NIH consensus development panel on osteoporosis prevention, diagnosis, and therapy: osteoporosis prevention, diagnosis, and therapy","volume":"285","author":"NIH-Panel","year":"2001","journal-title":"JAMA."},{"issue":"9320","key":"2024012714035482900_jbmr4494-bib-0002","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/S0140-6736(02)08706-8","article-title":"Pathogenesis of bone fragility in women and men","volume":"359","author":"Seeman","year":"2002","journal-title":"Lancet."},{"issue":"Suppl 2","key":"2024012714035482900_jbmr4494-bib-0003","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1007\/s00198-004-1702-6","article-title":"Epidemiology of osteoporotic fractures","volume":"16","author":"Johnell","year":"2005","journal-title":"Osteoporos Int."},{"issue":"2A","key":"2024012714035482900_jbmr4494-bib-0004","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/S0002-9343(97)90021-8","article-title":"Epidemiology and predictors of fractures associated with osteoporosis","volume":"103","author":"Lips","year":"1997","journal-title":"Am J Med."},{"issue":"11","key":"2024012714035482900_jbmr4494-bib-0005","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1007\/s00198-012-1931-z","article-title":"The burden of illness of osteoporosis in Canada","volume":"23","author":"Tarride","year":"2012","journal-title":"Osteoporos Int."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0006","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1359\/jbmr.061113","article-title":"Incidence and economic burden of osteoporosis-related fractures in the United States, 2005\u20132025","volume":"22","author":"Burge","year":"2007","journal-title":"J Bone Miner Res."},{"issue":"10","key":"2024012714035482900_jbmr4494-bib-0007","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1007\/s00198-016-3631-6","article-title":"The current economic burden of illness of osteoporosis in Canada","volume":"27","author":"Hopkins","year":"2016","journal-title":"Osteoporos Int."},{"issue":"8","key":"2024012714035482900_jbmr4494-bib-0008","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1002\/jbmr.2888","article-title":"A crisis in the treatment of osteoporosis","volume":"31","author":"Khosla","year":"2016","journal-title":"J Bone Miner Res."},{"issue":"9","key":"2024012714035482900_jbmr4494-bib-0009","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/s41574-019-0220-8","article-title":"Fracture prediction, imaging and screening in osteoporosis","volume":"15","author":"Fuggle","year":"2019","journal-title":"Nat Rev Endocrinol."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0010","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S8756-3282(96)00383-3","article-title":"Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry","volume":"20","author":"Cheng","year":"1997","journal-title":"Bone."},{"issue":"12","key":"2024012714035482900_jbmr4494-bib-0011","doi-asserted-by":"crossref","first-page":"6508","DOI":"10.1210\/jc.2005-1258","article-title":"In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography","volume":"90","author":"Boutroy","year":"2005","journal-title":"J Clin Endocrinol Metab."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0012","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S2213-8587(18)30308-5","article-title":"Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study","volume":"7","author":"Samelson","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"5","key":"2024012714035482900_jbmr4494-bib-0013","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/jbmr.3661","article-title":"External bone size is a key determinant of strength-decline trajectories of aging male radii","volume":"34","author":"Bigelow","year":"2019","journal-title":"J Bone Miner Res."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0014","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1002\/jbmr.3082","article-title":"Femoral neck external size but not aBMD predicts structural and mass changes for women transitioning through menopause","volume":"32","author":"Jepsen","year":"2017","journal-title":"J Bone Miner Res."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0015","doi-asserted-by":"crossref","first-page":"107650","DOI":"10.1016\/j.jsb.2020.107650","article-title":"External bone size identifies different strength-decline trajectories for the male human femora","volume":"212","author":"Bolger","year":"2020","journal-title":"J Struct Biol"},{"key":"2024012714035482900_jbmr4494-bib-0016","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.bone.2016.04.025","article-title":"Cluster analysis of bone microarchitecture from high resolution peripheral quantitative computed tomography demonstrates two separate phenotypes associated with high fracture risk in men and women","volume":"88","author":"Edwards","year":"2016","journal-title":"Bone."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0017","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s00223-017-0325-9","article-title":"Bone phenotype assessed by HRpQCT and associations with fracture risk in the GLOW study","volume":"102","author":"Litwic","year":"2018","journal-title":"Calcif Tissue Int."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0018","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s00223-019-00564-7","article-title":"Cluster analysis of finite element analysis and bone microarchitectural parameters identifies phenotypes with high fracture risk","volume":"105","author":"Westbury","year":"2019","journal-title":"Calcif Tissue Int."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0019","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/jbmr.3240","article-title":"Diabetes and deficits in cortical bone density, microarchitecture, and bone size: Framingham HR-pQCT study","volume":"33","author":"Samelson","year":"2018","journal-title":"J Bone Miner Res."},{"key":"2024012714035482900_jbmr4494-bib-0020","doi-asserted-by":"crossref","first-page":"129760","DOI":"10.1155\/2012\/129760","article-title":"Sex- and age-related differences in bone microarchitecture in men relative to women assessed by high-resolution peripheral quantitative computed tomography","volume":"2012","author":"Amin","year":"2012","journal-title":"J Osteoporos."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0021","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11657-017-0412-6","article-title":"The QUALYOR (QUalite Osseuse LYon Orleans) study: a new cohort for noninvasive evaluation of bone quality in postmenopausal osteoporosis. Rationale and study design","volume":"13","author":"Chapurlat","year":"2017","journal-title":"Arch Osteoporos"},{"issue":"11","key":"2024012714035482900_jbmr4494-bib-0022","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1002\/jbmr.124","article-title":"Association between bone turnover rate and bone microarchitecture in men: the STRAMBO study","volume":"25","author":"Chaitou","year":"2010","journal-title":"J Bone Miner Res."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0023","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1002\/jbmr.3105","article-title":"Bone microarchitecture assessed by HR-pQCT as predictor of fracture risk in postmenopausal women: the OFELY study","volume":"32","author":"Sornay-Rendu","year":"2017","journal-title":"J Bone Miner Res."},{"issue":"2","key":"2024012714035482900_jbmr4494-bib-0024","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/jbmr.3299","article-title":"Evaluation of radius microstructure and areal bone mineral density improves fracture prediction in postmenopausal women","volume":"33","author":"Biver","year":"2018","journal-title":"J Bone Miner Res."},{"issue":"5","key":"2024012714035482900_jbmr4494-bib-0025","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s00198-012-2160-1","article-title":"Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT","volume":"24","author":"Nishiyama","year":"2013","journal-title":"Osteoporos Int."},{"issue":"4","key":"2024012714035482900_jbmr4494-bib-0026","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1359\/jbmr.060110","article-title":"Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden","volume":"21","author":"Mellstrom","year":"2006","journal-title":"J Bone Miner Res."},{"issue":"7","key":"2024012714035482900_jbmr4494-bib-0027","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1007\/s00198-009-1062-3","article-title":"Does standardized BMD still remove differences between Hologic and GE-Lunar state-of-the-art DXA systems?","volume":"21","author":"Fan","year":"2010","journal-title":"Osteoporos Int."},{"issue":"9","key":"2024012714035482900_jbmr4494-bib-0028","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1007\/s00198-020-05438-5","article-title":"Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography","volume":"31","author":"Whittier","year":"2020","journal-title":"Osteoporos Int."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0029","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.bone.2012.03.003","article-title":"Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography","volume":"50","author":"Pauchard","year":"2012","journal-title":"Bone."},{"issue":"4","key":"2024012714035482900_jbmr4494-bib-0030","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.bone.2007.07.007","article-title":"Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis","volume":"41","author":"Buie","year":"2007","journal-title":"Bone."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0031","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/S8756-3282(02)00736-6","article-title":"Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images","volume":"30","author":"Pistoia","year":"2002","journal-title":"Bone."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0032","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.bone.2008.01.017","article-title":"Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method","volume":"42","author":"MacNeil","year":"2008","journal-title":"Bone."},{"key":"2024012714035482900_jbmr4494-bib-0033","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jbiomech.2018.08.030","article-title":"Harmonizing finite element modelling for non-invasive strength estimation by high-resolution peripheral quantitative computed tomography","volume":"80","author":"Whittier","year":"2018","journal-title":"J Biomech."},{"issue":"2\u20133","key":"2024012714035482900_jbmr4494-bib-0034","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/0098-3004(84)90020-7","article-title":"FCM: the fuzzy c-means clustering algorithm","volume":"10","author":"Bezdek","year":"1984","journal-title":"Comput Geosci."},{"key":"2024012714035482900_jbmr4494-bib-0035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.fss.2015.05.001","article-title":"A toolbox for fuzzy clustering using the R programming language","volume":"279","author":"Ferraro","year":"2015","journal-title":"Fuzzy Set Syst."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0036","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/BF02293907","article-title":"An examination of the effect of six types of error perturbation on fifteen clustering algorithms","volume":"45","author":"Milligan","year":"1980","journal-title":"Psychometrika."},{"issue":"3","key":"2024012714035482900_jbmr4494-bib-0037","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1145\/331499.331504","article-title":"Data clustering: a review","volume":"31","author":"Jain","year":"1999","journal-title":"ACM Comput Surv."},{"key":"2024012714035482900_jbmr4494-bib-0038","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/0377-0427(87)90125-7","article-title":"Silhouettes: a graphical aid to the interpretation and validation of cluster analysis","volume":"20","author":"Rousseeuw","year":"1987","journal-title":"J Comput Appl Math."},{"key":"2024012714035482900_jbmr4494-bib-0039","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.csda.2006.11.025","article-title":"Cluster-wise assessment of cluster stability","volume":"52","author":"Hennig","year":"2007","journal-title":"Comput Stat Data Anal."},{"issue":"21","key":"2024012714035482900_jbmr4494-bib-0040","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1016\/j.fss.2006.07.006","article-title":"A fuzzy extension of the silhouette width criterion for cluster analysis","volume":"157","author":"Campello","year":"2006","journal-title":"Fuzzy Set Syst."},{"issue":"7","key":"2024012714035482900_jbmr4494-bib-0041","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1002\/jbmr.3129","article-title":"Cross-sectional versus longitudinal change in a prospective HR-pQCT study","volume":"32","author":"Burt","year":"2017","journal-title":"J Bone Miner Res."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0042","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/00224065.1969.11980344","article-title":"Hazard plotting for incomplete failure data","volume":"1","author":"Nelson","year":"1969","journal-title":"J Qual Technol."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0043","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/biomet\/69.1.239","article-title":"Partial residuals for the proportional hazards regression model","volume":"69","author":"Schoenfeld","year":"1982","journal-title":"Biometrika."},{"issue":"11","key":"2024012714035482900_jbmr4494-bib-0044","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1002\/jbmr.2873","article-title":"Sex- and site-specific normative data curves for HR-pQCT","volume":"31","author":"Burt","year":"2016","journal-title":"J Bone Miner Res."},{"issue":"21","key":"2024012714035482900_jbmr4494-bib-0045","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1056\/NEJMra053077","article-title":"Bone quality\u2014the material and structural basis of bone strength and fragility","volume":"354","author":"Seeman","year":"2006","journal-title":"N Engl J Med."},{"issue":"8","key":"2024012714035482900_jbmr4494-bib-0046","doi-asserted-by":"crossref","first-page":"2530","DOI":"10.1007\/s11999-015-4184-2","article-title":"Women build long bones with less cortical mass relative to body size and bone size compared with men","volume":"473","author":"Jepsen","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"2024012714035482900_jbmr4494-bib-0047","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1359\/jbmr.1998.13.5.763","article-title":"A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men","volume":"13","author":"Riggs","year":"1998","journal-title":"J Bone Miner Res."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0048","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/0002-9343(83)90860-4","article-title":"Evidence for two distinct syndromes of involutional osteoporosis","volume":"75","author":"Riggs","year":"1983","journal-title":"Am J Med"},{"issue":"10","key":"2024012714035482900_jbmr4494-bib-0049","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1002\/jbmr.3481","article-title":"Normative standards for HRpQCT parameters in Chinese men and women","volume":"33","author":"Zhu","year":"2018","journal-title":"J Bone Miner Res."},{"issue":"10","key":"2024012714035482900_jbmr4494-bib-0050","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1002\/jbmr.1953","article-title":"Differences in skeletal microarchitecture and strength in African-American and white women","volume":"28","author":"Putman","year":"2013","journal-title":"J Bone Miner Res."},{"issue":"6","key":"2024012714035482900_jbmr4494-bib-0051","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/jbmr.3399","article-title":"Sex-, ethnic-, and age-specific centile curves for pQCT- and HR-pQCT-derived measures of bone structure and strength in adolescents and young adults","volume":"33","author":"Gabel","year":"2018","journal-title":"J Bone Miner Res."},{"issue":"10","key":"2024012714035482900_jbmr4494-bib-0052","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1007\/s00198-015-3156-4","article-title":"Bone structure assessed by HR-pQCT, TBS and DXL in adult patients with different types of osteogenesis imperfecta","volume":"26","author":"Kocijan","year":"2015","journal-title":"Osteoporos Int."},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0053","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s13023-020-01521-6","article-title":"Spectrum of microarchitectural bone disease in inborn errors of metabolism: a cross-sectional, observational study","volume":"15","author":"Sidhu","year":"2020","journal-title":"Orphanet J Rare Dis"},{"issue":"1","key":"2024012714035482900_jbmr4494-bib-0054","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/jbmr.171","article-title":"Age-related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population-based HR-pQCT study","volume":"26","author":"Macdonald","year":"2011","journal-title":"J Bone Miner Res."}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jbmr.4494","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jbmr.4494","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/37\/3\/428\/55460324\/jbmr4494.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/37\/3\/428\/55460324\/jbmr4494.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T15:08:23Z","timestamp":1710342503000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/37\/3\/428-439\/7516872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,12,25]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.4494","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12,1]]},"published":{"date-parts":[[2020,12,1]]},"assertion":[{"value":"2021-10-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}