Performance of U.S.-FRAX by race and ethnicity for short-term hip and major osteoporotic fracture prediction in U.S. women with rheumatoid arthritis
Authors' conclusion
The modest discrimination and insufficient calibration data in all racial and ethnic RA groups studied underscore the need for larger studies in diverse RA populations.
Study context
- Population
- Women aged ≥65 yr with RA, U.S. national Rheumatology Informatics System for Effectiveness registry linked to Medicare claims (2016–2018)
- Participants
- 14,533 women
- Exposure
- Performance of race- and ethnicity-adapted U.S.-FRAX without BMD across racial and ethnic groups
- Outcome
- Performance (discrimination) of U.S.-FRAX without BMD for predicting hip fracture and MOF
- Follow-up
- 2-yr
Methodological detailsregistry linked to Medicare claims
- Registry linked to Medicare claims
Main finding
As reported in the abstract
Discrimination of U.S.-FRAX (cross-validated AUC)
Overall AUC, hip fracture
0.71
95% CI 0.69–0.73
Overall AUC, major osteoporotic fracture (MOF)
0.66
95% CI 0.65–0.68
Observational data: associations, not effects.
Further findings
Hip fracture incidence (per 1000 PY)
Per 1000 person-years (PY)
| Outcome | White | Black or African American | Hispanic or Latina | Asian |
|---|---|---|---|---|
| MOF incidence (per 1000 PY)Lowest in Black or African American, highest in White | 58.7 | 26.0 | — not stated in the abstract | — not stated in the abstract |
— not stated in the abstract
- Hip fracture incidence (per 1000 PY) — Overall hip fracture incidence (per 1000 PY)
- 15.3
- MOF incidence (per 1000 PY) — Overall MOF incidence (per 1000 PY)
- 55.8
Calibration
- Short observation period precluded formal calibration testing; U.S.-FRAX without BMD may underestimate MOF risk, particularly among Black or African and Hispanic or Latina women
Original publication
Performance of U.S.-FRAX by race and ethnicity for short-term hip and major osteoporotic fracture prediction in U.S. women with rheumatoid arthritis. J Bone Miner Res. Published 17 February 2026. doi:10.
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