Use of DXA-derived 3D-modeling, as implemented by 3D-Shaper, for the assessment of fracture risk in a population-based setting
Authors' conclusion
DXA-derived 3D modeled parameters are highly correlated to aBMD and do not provide additional value for the estimation of fracture risk beyond aBMD alone.
Study context
- Population
- Rotterdam Study participants with hip DXA scans; 56% women, mean age 67.4 (SD = 10.1) years
- Participants
- 4,908 participants
- Exposure
- aBMD vs DXA-derived 3D-modeled csBMD and tvBMD for fracture risk
- Outcome
- Incident any-type and hip fractures; HR per SD decrease in BMD (Cox regression adjusted for multiple confounders)
- Follow-up
- Mean 6.8 (SD = 2.5) years
Main finding
As reported in the abstract
Fracture risk per SD decrease in BMD (total hip)
| Group | HR any-type fracture | HR hip fracture |
|---|---|---|
| aBMD | 1.60 (95% CI: 1.43-1.78) | 2.46 (95% CI: 1.90-3.17) |
| csBMD | 1.44 (95% CI: 1.30-1.60) | 1.76 (95% CI: 1.39-2.23) |
| tvBMD | 1.62 (95% CI: 1.45-1.80) | 2.44 (95% CI: 1.88-3.15) |
HR any-type fracture
aBMD1.60 (95% CI: 1.43-1.78)
csBMD1.44 (95% CI: 1.30-1.60)
tvBMD1.62 (95% CI: 1.45-1.80)
HR hip fracture
aBMD2.46 (95% CI: 1.90-3.17)
csBMD1.76 (95% CI: 1.39-2.23)
tvBMD2.44 (95% CI: 1.88-3.15)
- Hip fractures
- 171
- Any-type fractures
- 1019
Observational data: associations, not effects.
Further findings
Correlation between aBMD and 3D parameters, and between csBMD and tvBMD
- aBMD vs modeled 3D parameters, r
- r = >.81; p < .001
- csBMD vs tvBMD at total hip, r
- r = 0.85; p < .001
csBMD and tvBMD in the same model
- Any-type fracture: csBMD HR
- 0.96, 95% CI: 0.81-1.13
- Any-type fracture: tvBMD HR
- 1.67, 95% CI: 1.41-1.98
- Hip fracture: csBMD HR
- 0.83, 95% CI: 0.58-1.21
- Hip fracture: tvBMD HR
- 2.82, 95% CI: 1.94-4.10
- Inclusion of aBMD with tvBMD or csBMD: high multicollinearity (VIF > 5)
- Similar results at neck and intertrochanteric regions
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Use of DXA-derived 3D-modeling, as implemented by 3D-Shaper, for the assessment of fracture risk in a population-based setting. J Bone Miner Res. Published 2 September 2025. doi:10.
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