Table 3

Summary features of the three most studied tools, as deemed relevant for the selection of the instrument in clinical and research settings

 Number of clinical risk factors11195
 Requirement for BMDOptionalNoOptional
 Algorithm accessible for individual useYesNo*Yes
 Male and femaleYesYesYes
 Age range40–9035–10050–96
 Prediction intervals101, 2, …, 105, 10
 Type of fracture—hipYesYesYes
 Type of fracture—MOPYesYesYes
 Countries57UK only3
 Inclusion in national guidelinesYesYesYes
 Validated in a separate cohortYesYesY (BMD only)
 Independent validation†YesYesY (BMD only)
 Number of validation studies2636‡
 Population basis for validation, N4 624 4383 485 952§229 162
 Population basis for validation, countriesUK only
 Average quality of studies (QUADAS-2)Globally similar (see online supplementary figure S2)
 Duration of follow-up equal to tool estimation intervalYesYes (10 year only)Yes (5 and 10 year)
 Consideration of national fracture epidemiologyYesNoNo
 Consideration of background mortalityYesNoNo
 AUC (95% CI)—hip, females, without BMD0.74 (0.68 to 0.80)0.89 (0.88 to 0.89)NA
 AUC (95% CI)—hip, females, with BMD0.79 (0.73 to 0.85)NA0.74 (0.61 to 0.87)
 AUC (95% CI)—hip, males, without BMD0.71 (0.65 to 0.77)0.87 (0.86 to 0.88)NA
 AUC (95% CI)—hip, males, with BMD0.77 (NA)**NA0.85 (NA)**
 AUC (95% CI)—MOP††††††
  • *QFracture was removed from the website in 2012. Only the updated version is now available, but is not suitable for meta-analysis as it has only been the subject of one validation study.

  • †That is, by independent research groups.

  • ‡Only with BMD.

  • §Does not include the updated QFracture (2012) study.

  • ¶We did not consider the study that included data from 10 countries.

  • **One study only.

  • ††Comparison is inadequate because of different definitions of MOP for each tool.

  • AUC, area under the curve; BMD, bone mineral density; MOP, major osteoporotic fractures; NA, not applicable/not available; QUADAS, Quality Assessment Tool for Diagnostic Accuracy Studies.