{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:33:19Z","timestamp":1791261199553,"version":"4.1.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2017-02229"],"award-info":[{"award-number":["2017-02229"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 178098"],"award-info":[{"award-number":["PJT 178098"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Arthritis Musculoskeletal and Skin Diseases of the National Institutes of Health","award":["R01AR061445, AR027065"],"award-info":[{"award-number":["R01AR061445, AR027065"]}]},{"name":"National Heart, Lung, and Blood Institute Framingham Heart Study","award":["N01-HC-25195, HHSN268201500001I"],"award-info":[{"award-number":["N01-HC-25195, HHSN268201500001I"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The Microarchitecture Fracture Risk Assessment Calculator ($\\mu $FRAC) was developed to predict osteoporotic fracture risk using direct measures of bone microarchitecture. However, its performance has not yet been externally validated in women. This study aims to evaluate the performance of the $\\mu $FRAC model in predicting osteoporotic fracture risk in a cohort of older women. The performance of $\\mu $FRAC was assessed in a population of 2307 postmenopausal women aged 75-80 yr in Gothenburg, Sweden. All participants underwent HR-pQCT scanning of the distal radius and distal tibia (82 $\\mu $m). Incident fracture information was collected from regional X-ray archives up until March 2023. The $\\mu $FRAC 5- and 10-yr risk of major osteoporotic fracture (MOF) and any osteoporotic fracture were calculated for all participants. The model discrimination was assessed using receiver operator characteristic (ROCs) curves and area under the curve (AUCs). FRAX and femoral neck areal bone mineral density (FN aBMD) were used as reference models for comparison. During the follow-up period (mean 6.82 $\\pm $ 2.48 yr), 584 participants (25.3%) sustained an MOF. The AUCs for MOF models for 5- and 10-yr predictions were similar for $\\mu $FRAC (AUC = 0.601-0.634) compared with reference models of FRAX (AUC = 0.615-0.618) and FN aBMD (AUC = 0.596). Overall, $\\mu $FRAC showed good generalizability (regression slope 0.82-1.00) to the external cohort. Fracture risk prediction by $\\mu $FRAC was demonstrated to perform consistently with FRAX and FN aBMD in this external cohort of elderly females, suggesting it is a viable alternative fracture risk prediction tool. A benefit of $\\mu $FRAC is that it is based on bone microarchitecture rather than binary clinical risk factors, so it has potential to be sensitive to changes in bone fragility as a function of age-related deterioration or anti-osteoporosis treatment.<\/jats:p>","DOI":"10.1093\/jbmrpl\/ziaf117","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T10:53:49Z","timestamp":1754304829000},"source":"Crossref","is-referenced-by-count":2,"title":["External validation of a novel HR-pQCT fracture risk assessment tool (<b>\u03bc<\/b>FRAC) in a female cohort: Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) study"],"prefix":"10.1093","volume":"9","author":[{"given":"Annabel R","family":"Bugbird","sequence":"first","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary , Calgary AB, T2N 4Z6 ,","place":["Canada"]},{"name":"Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary , Calgary AB, T2N 1N4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raju","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg , SE-413 45 Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle E","family":"Whittier","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary , Calgary AB, T2N 4Z6 ,","place":["Canada"]},{"name":"Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary , Calgary AB, T2N 4N1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven K","family":"Boyd","sequence":"additional","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary , Calgary AB, T2N 4Z6 ,","place":["Canada"]},{"name":"Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary , Calgary AB, T2N 1N4 ,","place":["Canada"]},{"name":"Department of Radiology, Cumming School of Medicine, University of Calgary , Calgary AB, T2N 2T9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Lorentzon","sequence":"additional","affiliation":[{"name":"Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg , SE-413 45 Gothenburg ,","place":["Sweden"]},{"name":"Region V\u00e4stra G\u00f6taland, Department of Geriatric Medicine, Sahlgrenska University Hospital , SE-431 80, M\u00f6lndal ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"issue":"1","key":"2025091919254254100_ref1","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s00198-011-1822-8","article-title":"Relationship of femoral neck areal bone mineral density to volumetric bone mineral density, bone size, and femoral strength in men and women","volume":"23","author":"Srinivasan","year":"2012","journal-title":"Osteoporos Int"},{"issue":"9","key":"2025091919254254100_ref2","doi-asserted-by":"publisher","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":"2025091919254254100_ref3","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jocd.2017.06.008","article-title":"Worldwide fracture prediction","volume":"20","author":"Fuleihan","year":"2017","journal-title":"J Clin Densitom"},{"issue":"8","key":"2025091919254254100_ref4","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1002\/jbmr.1956","article-title":"Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? 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