{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:12:14Z","timestamp":1792156334164,"version":"4.4.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000033","name":"Institute of Musculoskeletal Health and Arthritis","doi-asserted-by":"publisher","award":["364554"],"award-info":[{"award-number":["364554"]}],"id":[{"id":"10.13039\/501100000033","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Bone &amp; Mineral Res"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Most fracture risk assessment tools use clinical risk factors combined with bone mineral density (BMD) to improve assessment of osteoporosis; however, stratifying fracture risk remains challenging. This study developed a fracture risk assessment tool that uses information about volumetric bone density and three\u2010dimensional structure, obtained using high\u2010resolution peripheral quantitative compute tomography (HR\u2010pQCT), to provide an alternative approach for patient\u2010specific assessment of fracture risk. Using an international prospective cohort of older adults (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20096802) we developed a tool to predict osteoporotic fracture risk, called \u03bcFRAC. The model was constructed using random survival forests, and input predictors included HR\u2010pQCT parameters summarizing BMD and microarchitecture alongside clinical risk factors (sex, age, height, weight, and prior adulthood fracture) and femoral neck areal BMD (FN aBMD). The performance of \u03bcFRAC was compared to the Fracture Risk Assessment Tool (FRAX) and a reference model built using FN aBMD and clinical covariates. \u03bcFRAC was predictive of osteoporotic fracture (c\u2010index\u2009=\u20090.673,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), modestly outperforming FRAX and FN aBMD models (c\u2010index\u2009=\u20090.617 and 0.636, respectively). Removal of FN aBMD and all clinical risk factors, except age, from \u03bcFRAC did not significantly impact its performance when estimating 5\u2010year and 10\u2010year fracture risk. The performance of \u03bcFRAC improved when only major osteoporotic fractures were considered (c\u2010index\u2009=\u20090.733,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). We developed a personalized fracture risk assessment tool based on HR\u2010pQCT that may provide an alternative approach to current clinical methods by leveraging direct measures of bone density and structure. \u00a9 2023 The Authors.\n                    <jats:italic>Journal of Bone and Mineral Research<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).\n                  <\/jats:p>","DOI":"10.1002\/jbmr.4808","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T07:06:09Z","timestamp":1683097569000},"page":"1234-1244","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["A Fracture Risk Assessment Tool for High Resolution Peripheral Quantitative Computed Tomography"],"prefix":"10.1093","volume":"38","author":[{"given":"Danielle 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