Osteoporosis, bone & mineral

Response regarding FRAX performance across race/ethnicity and genetic risk in the women’s health initiative

J Bone Miner ResPublished Author response to correspondence

Study context

Population
Women in the Women's Health Initiative
Comparison
FRAX performance across race/ethnicity and polygenic-score groups
Methodological detailssecondary analysis of the Women's Health Initiative cohort, age-stratified analyses, competing-risk cumulative incidence, inverse probability of censoring weighting, Limitations: informative censoring differing across racial and ethnic groups, sparse subgroup events, multiple comparisons, limited cross-ancestry portability
  • Secondary analysis of the Women's Health Initiative cohort
  • Age-stratified analyses
  • Competing-risk cumulative incidence
  • Inverse probability of censoring weighting
  • Limitations: informative censoring differing across racial and ethnic groups, sparse subgroup events, multiple comparisons, limited cross-ancestry portability

Primary result

As reported in the abstract

FRAX performance across race/ethnicity and genetic risk
  • Age-stratified analyses showed a similar qualitative pattern of overestimation in Black and Hispanic/Latina women
  • With medium polygenic-score group as reference, associations with major osteoporotic fracture remained directionally consistent
  • IPCW estimates similar for major osteoporotic fracture but less stable for hip fracture
  • Adding the polygenic score produced only modest gains in time-dependent discrimination
  • Observed fracture probability estimated by cumulative incidence with death as a competing event

Original publication

Response regarding FRAX performance across race/ethnicity and genetic risk in the women’s health initiative. J Bone Miner Res. Published 12 September 2026. doi:10.1093/jbmr/zjag134

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