{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T06:13:12Z","timestamp":1770963192443,"version":"3.50.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>High-altitude environments in China are associated with altered bone metabolism and an increased risk of osteoporotic fractures. Given the limited availability of dual-energy X-ray absorptiometry (DXA) in these regions, the FRAX tool provides a practical alternative for fracture risk assessment. However, the screening performance and diagnostic performance of FRAX in plateau populations remain unclear. This study systematically evaluated the diagnostic accuracy of FRAX\u2014probability of major osteoporotic fracture (PMOF), probability of hip fracture (PHF), and FRAX high-risk thresholds\u2014in high-altitude areas in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six English and Chinese databases were searched from inception to December 31, 2025. Studies reporting true-positive, false-positive, false-negative, and true-negative values for FRAX in populations residing above 1,500 m were included. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated using random-effects models. Heterogeneity was explored through meta-regression and subgroup analyses based on region, bone mineral density (BMD) inclusion, reference standard, gender, and study design. Sensitivity analyses excluding studies with high or unclear Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) risk were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies were included. For PMOF, the pooled sensitivity and specificity were 0.70 and 0.82, respectively (AUC = 0.82), while PHF yielded pooled estimates of 0.68 and 0.84, respectively (AUC = 0.82). Both analyses showed substantial heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      &amp;gt; 90%). Subgroup analyses indicated higher specificity in Qinghai\u2013Tibet Plateau populations and mixed-gender cohorts. Meta-regression identified region, BMD inclusion, reference standard, and gender as contributors to heterogeneity. Sensitivity analyses excluding lower-quality studies produced similar estimates. Only three studies evaluated the FRAX high-risk threshold, and the extremely wide confidence intervals\u2014particularly for specificity (95% CI: 0.32\u20130.98)\u2014indicated marked imprecision.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FRAX may provide preliminary and exploratory information for fracture risk screening in high-altitude settings; however, the evidence remains limited and imprecise, precluding firm conclusions regarding its clinical usefulness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/inplasy.com\/wp-content\/uploads\/2025\/01\/INPLASY-Protocol-7296.pdf<\/jats:ext-link>\n                      , identifier INPLASY202510040.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1656377","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:21:55Z","timestamp":1770960115000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Application value of FRAX in high-altitude areas in China: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Yong","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Hospital, Daxing Teaching Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Oncology, Daxing Teaching Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ting-Ting","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Daxing Teaching Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2020.06.004","article-title":"Osteoporosis in older adults","volume":"104","author":"Johnston","year":"2020","journal-title":"Med Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12873","article-title":"Treating osteoporosis to prevent fractures: current concepts and future developments","volume":"285","author":"Lorentzon","year":"2019","journal-title":"J Intern Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1007\/s11657-020-00827-z","article-title":"FRAX: re-adjust or re-think","volume":"15","author":"El Miedany","year":"2020","journal-title":"Arch Osteoporos"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06435-6","article-title":"Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan","volume":"33","author":"Vandenput","year":"2022","journal-title":"Osteoporos Int"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.12114\/j.issn.1007-9572.2023.0121","article-title":"Guidelines for the diagnosis and treatment of primary osteoporosis (2022)","volume":"26","year":"2023","journal-title":"Chin Gen Pract"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.13820\/j.cnki.gdyx.2016.12.011","article-title":"Analysis of factors affecting fracture healing in high-altitude areas","volume":"37","author":"Du","year":"2016","journal-title":"Guangdong Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1006-7108.2022.09.015","article-title":"Survey of quantitative CT bone density and osteoporosis prevalence in middle-aged and elderly people in kunming area","volume":"28","author":"Yang","year":"2022","journal-title":"Chin J Osteoporos"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1006-1959.2020.23.011","article-title":"Research status of osteoporosis in high-altitude areas of China","volume":"33","author":"Wang","year":"2020","journal-title":"Med Inf"},{"key":"B9","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1186\/s41043-025-00994-0","article-title":"A review of the relationship between gut microbiota and osteoporosis in high altitude environments","volume":"44","author":"Qiao","year":"2025","journal-title":"J Health Popul Nutr"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2022.114206","article-title":"China Multi-Ethnic Cohort (CMEC). 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