Uncovering racial and genetic disparities in FRAX performance for fracture risk assessment in postmenopausal women
Authors' conclusion
Calibration analyses revealed systematic inaccuracies, highlighting racial disparities in overestimating fracture risk and genetic disparities in underestimating fracture risk predictions.
Study context
- Population
- Postmenopausal women aged 50–79 yr in the Women's Health Initiative
- Participants
- 27,512 women
- Exposure
- FRAX-predicted vs observed fracture risk across racial/ethnic and GPS genetic risk groups
- Outcome
- Accuracy of FRAX (with and without BMD) in predicting fracture risk vs observed outcomes
- Follow-up
- 10 yr
Methodological details10 yr follow-up, stratified by race/ethnicity and genetic risk categories
- 10 yr follow-up
- Stratified by race/ethnicity and genetic risk categories
Main finding
As reported in the abstract
Fracture risk, FRAX with BMD vs observed
Hazard ratio (95% CI)P value
African Americanvs Non-Hispanic WhiteFRAX overestimated risk by 82%
0.18(0.10–0.36)
P < 0.001Hispanicvs Non-Hispanic WhiteFRAX overestimated risk by 48%
0.52(0.31–0.87)
P < 0.001Top 5% GPSvs Low GPSFRAX underestimated risk
2.15(1.22–3.68)
P < 0.001Observational data: associations, not effects.
Further findings
Sensitivity analyses by estrogen use
- Findings persisted regardless of estrogen use
Original publication
Uncovering racial and genetic disparities in FRAX performance for fracture risk assessment in postmenopausal women. J Bone Miner Res. Published 30 October 2025. doi:10.
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