{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T17:06:18Z","timestamp":1794071178228,"version":"4.8.0"},"reference-count":17,"publisher":"The Endocrine Society","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>Context:<\/jats:title>\n                  <jats:p>Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective:<\/jats:title>\n                  <jats:p>The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design:<\/jats:title>\n                  <jats:p>This was a prospective, observational cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting:<\/jats:title>\n                  <jats:p>The study was conducted at primary care practices in 10 countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients:<\/jats:title>\n                  <jats:p>Women aged 55 years or older participated in the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention:<\/jats:title>\n                  <jats:p>Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure:<\/jats:title>\n                  <jats:p>The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm\/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jc.2013-3468","type":"journal-article","created":{"date-parts":[[2014,1,14]],"date-time":"2014-01-14T10:06:36Z","timestamp":1389693996000},"page":"817-826","source":"Crossref","is-referenced-by-count":15,"title":["Empirically Based Composite Fracture Prediction Model From the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)"],"prefix":"10.1210","volume":"99","author":[{"given":"Gordon","family":"FitzGerald","sequence":"first","affiliation":[{"name":"Center for Outcomes Research (G.F., D.W.H., F.A.A., F.H.H., S.H.G.) University of Massachusetts Medical School, Worcester, Massachusetts 01605"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet E.","family":"Compston","sequence":"first","affiliation":[{"name":"University of Cambridge School of Clinical Medicine (J.E.C.), Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland D.","family":"Chapurlat","sequence":"first","affiliation":[{"name":"Division of Rheumatology (R.D.C.), INSERM Unit\u00e9 Mixte de Recherche 1033, Universit\u00e9 de Lyon, and Department of Orthopedics and Rheumatology, H\u00f4pital E. Herriot, 69003 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Pfeilschifter","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III (J.P.), Alfried Krupp Krankenhaus, Essen D-45276, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Cooper","sequence":"first","affiliation":[{"name":"Medical Research Council Lifecourse Epidemiology Unit (C.C.), University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom"},{"name":"National Institute for Health Research Musculoskeletal Biomedical Research Unit (C.C.), University of Oxford, Oxford OX1 3QX, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Hosmer","sequence":"first","affiliation":[{"name":"Center for Outcomes Research (G.F., D.W.H., F.A.A., F.H.H., S.H.G.) University of Massachusetts Medical School, Worcester, Massachusetts 01605"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Adachi","sequence":"first","affiliation":[{"name":"St Joseph's Hospital (J.D.A.), McMaster University, Hamilton, Ontario, Canada L8N 1Y2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Anderson","sequence":"first","affiliation":[{"name":"Center for Outcomes Research (G.F., D.W.H., F.A.A., F.H.H., S.H.G.) University of Massachusetts Medical School, Worcester, Massachusetts 01605"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo","family":"D\u00edez-P\u00e9rez","sequence":"first","affiliation":[{"name":"Hospital del Mar-IMIM-Autonomous University of Barcelona (A.D.-P.), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Greenspan","sequence":"first","affiliation":[{"name":"Research Network on Aging and Frailty, Le Fonds europ\u00e9en de d\u00e9veloppement r\u00e9gional (European Regional Development Fund), Instituto de Salud Carlos III, 28029 Madrid, Spain;University of Pittsburgh (S.L.G.), Pittsburgh, Pennsylvania 15213"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Coen","family":"Netelenbos","sequence":"first","affiliation":[{"name":"Department of Endocrinology (J.C.N.), VU University Medical Centre, Amsterdam 2131PM Hoofddorp, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeri W.","family":"Nieves","sequence":"first","affiliation":[{"name":"Helen Hayes Hospital and Columbia University (J.W.N.), West Haverstraw, New York 10993"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Rossini","sequence":"first","affiliation":[{"name":"Section of Rheumatology (M.R.), Department of Medicine, University of Verona, 37129 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson B.","family":"Watts","sequence":"first","affiliation":[{"name":"Mercy Health (N.B.W.), Cincinnati, Ohio 45236"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick H.","family":"Hooven","sequence":"first","affiliation":[{"name":"Center for Outcomes Research (G.F., D.W.H., F.A.A., F.H.H., S.H.G.) University of Massachusetts Medical School, Worcester, Massachusetts 01605"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Z.","family":"LaCroix","sequence":"first","affiliation":[{"name":"Fred Hutchinson Cancer Research Center (A.Z.L.), Seattle, Washington 98109"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyn","family":"March","sequence":"first","affiliation":[{"name":"University of Sydney Institute of Bone and Joint Research and Department of Rheumatology (L.M.), Royal North Shore Hospital, 2006 Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Roux","sequence":"first","affiliation":[{"name":"Paris Descartes University and Cochin Hospital (C.R.), 75014 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth G.","family":"Saag","sequence":"first","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology (K.G.S.), University of Alabama at Birmingham, Birmingham, Alabama 35294"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethel S.","family":"Siris","sequence":"first","affiliation":[{"name":"Columbia University Medical Center (E.S.S.), New York, New York 10032"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Silverman","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Cedars-Sinai Medical Center (S.S.), Los Angeles, California 90211"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H.","family":"Gehlbach","sequence":"first","affiliation":[{"name":"Center for Outcomes Research (G.F., D.W.H., F.A.A., F.H.H., S.H.G.) University of Massachusetts Medical School, Worcester, Massachusetts 01605"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071613085391900_B1","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1007\/s001980170006","article-title":"Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds","volume":"12","author":"Kanis","year":"2001","journal-title":"Osteoporos Int"},{"key":"2020071613085391900_B2","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1007\/s00198-008-0588-0","article-title":"Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks","volume":"19","author":"Nguyen","year":"2008","journal-title":"Osteoporos Int"},{"key":"2020071613085391900_B3","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1001\/jama.284.7.876","article-title":"Risk stratification and therapeutic decision making in acute coronary syndromes","volume":"284","author":"Ohman","year":"2000","journal-title":"JAMA"},{"key":"2020071613085391900_B4","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1001\/archinternmed.2009.404","article-title":"A comparison of prediction models for fractures in older women: is more better?","volume":"169","author":"Ensrud","year":"2009","journal-title":"Arch Intern Med"},{"key":"2020071613085391900_B5","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s00198-007-0343-y","article-title":"The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women","volume":"18","author":"Kanis","year":"2007","journal-title":"Osteoporos Int"},{"key":"2020071613085391900_B6","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1002\/jbmr.1652","article-title":"Differing risk profiles for individual fracture sites: evidence from the Global Longitudinal Study of Osteoporosis in Women (GLOW)","volume":"27","author":"FitzGerald","year":"2012","journal-title":"J Bone Miner Res"},{"key":"2020071613085391900_B7","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s00198-009-0958-2","article-title":"The Global Longitudinal Study of Osteoporosis in Women (GLOW): rationale and study design","volume":"20","author":"Hooven","year":"2009","journal-title":"Osteoporos Int"},{"key":"2020071613085391900_B8","doi-asserted-by":"crossref","DOI":"10.1002\/9780470258019","volume-title":"Applied Survival Analysis: Regression Modeling of Time to Event Data","author":"Hosmer","year":"2008","edition":"2nd ed"},{"key":"2020071613085391900_B9","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2307\/2986270","article-title":"Regression using fractional polynomials of continuous covariates: parsimonious parametric modelling","volume":"43","author":"Royston","year":"1994","journal-title":"Appl Statistics"},{"key":"2020071613085391900_B10","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-3462-1","volume-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis","author":"Harrell","year":"2001","edition":"1st ed"},{"key":"2020071613085391900_B11","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol\u2014a new facility for the measurement of health-related quality of life","volume":"16","author":"The EuroQol Group","year":"1990","journal-title":"Health Policy"},{"key":"2020071613085391900_B12","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1023\/B:LIDA.0000036393.29224.1d","article-title":"A cautionary note on the use of the Gronnesby and Borgan goodness-of-fit test for the Cox proportional hazards model","volume":"10","author":"May","year":"2004","journal-title":"Lifetime Data Anal"},{"key":"2020071613085391900_B13","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1001\/jama.1982.03320430047030","article-title":"Evaluating the yield of medical tests","volume":"247","author":"Harrell","year":"1982","journal-title":"JAMA"},{"key":"2020071613085391900_B14","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1002\/jbmr.215","article-title":"Evaluation of the FRAX and Garvan fracture risk calculators in older women","volume":"26","author":"Bolland","year":"2011","journal-title":"J Bone Miner Res"},{"key":"2020071613085391900_B15","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/jbmr.1729","article-title":"Predictive value of FRAX for fracture in obese older women","volume":"28","author":"Premaor","year":"2013","journal-title":"J Bone Miner Res"},{"key":"2020071613085391900_B16","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/jbmr.1466","article-title":"The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women","volume":"27","author":"Prieto-Alhambra","year":"2012","journal-title":"J Bone Miner Res"},{"key":"2020071613085391900_B17","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1359\/jbmr.091004","article-title":"Obesity and fractures in postmenopausal women","volume":"25","author":"Premaor","year":"2010","journal-title":"J Bone Miner Res"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/99\/3\/817\/11157934\/jcem0817.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/99\/3\/817\/11157934\/jcem0817.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T23:08:05Z","timestamp":1594940885000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/99\/3\/817\/2537303"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,1]]},"references-count":17,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,3,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jc.2013-3468","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3,1]]}}}