High fracture probability with FRAX® usually indicates densitometric osteoporosis: Implications for clinical practice
Bibliographic record
Abstract
Summary: Most patients designated as high risk of fracture using fracture risk assessment tool ( FRAX® ) with femoral neck bone mineral density ( BMD ) ( i.e., 10-year major osteoporotic fracture probability exceeding 20% or hip fracture exceeding 3% ) have one or more T-scores in the osteoporotic range; conversely, almost no high risk patients have normal T-scores at all bone mineral density measurement sites. Introduction: We determined the agreement between a FRAX® designation of high risk of fracture [defined as 10-year major osteoporotic fracture probability ( ≥20% ) or hip fracture probability ( ≥3% )] and the WHO categorizations of bone mineral density according to T-score. Methods: Ten-year FRAX® probabilities calculated with femoral neck BMD were derived using both Canadian and US white tools for a large clinical cohort of 36,730 women and 2,873 men age 50 years and older from Manitoba, Canada. Individuals were classified according to FRAX fracture probability and BMD T-scores alone. Results: Most individuals designated by FRAX as high risk of major osteoporotic fracture had a T-score in the osteoporotic range at one or more BMD measurement sites ( 85% with Canadian tool and 83% with US white tool ). The majority of individuals deemed at high risk of hip fracture had one or more T-scores in the osteoporotic range ( 66% with Canadian tool and 64% with US white tool ). Conversely, there were extremely few individuals ( < 1% ) who were at high risk of major osteoporotic or hip fracture with normal T-scores at all BMD measurement sites. Conclusions: A FRAX designation of high risk of fracture is usually associated with a densitometric diagnosis of osteoporosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.047 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".