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FRAX and mandibular sparse trabeculation as fracture predictors: a longitudinal study from 1980 to 2002.

Journal article
Authors Valter Sundh
Dominique Hange
Margareta Ahlqwist
Magnus Hakeberg
Lauren Lissner
Grethe Jonasson
Published in European journal of oral sciences
Volume 125
Issue 2
Pages 135-140
ISSN 1600-0722
Publication year 2017
Published at Institute of Odontology
Institute of Medicine, Department of Public Health and Community Medicine
Pages 135-140
Language en
Keywords bone density; bone fracture; osteoporosis; population study; radiography
Subject categories Health Sciences, Basic Medicine, Gerontology, specializing in Medical and Health Sciences, Other Medical Sciences not elsewhere specified


The fracture assessment tool (FRAX) is widely used for predicting fractures, but better methods are needed. The aim of this study was to determine whether visual assessments of mandibular trabecular bone could improve FRAX predictions. Three age-cohorts of women were examined twice - 499 women in 1980/1981 and 412 women in 1992/1993; 397 participated in both examinations. Information on 10-yr fracture events was available, and bone trabeculation was assessed in radiographs as 'dense', 'mixed', or 'sparse'. Fracture assessment tool values, without bone mineral density (BMD), were calculated twice. Both sparse trabeculation and FRAX >15% were associated with a twofold higher risk for future fracture in the younger group and with a three- to fourfold higher risk for future fracture in the older group. For those with both FRAX >15% and sparse trabeculation, the relative risk (RR) for a fracture in the next 10 yr was 5.9 (95% CI: 3.5-9.8) in the younger group and 22.7 (95% CI: 5.6-92) in the older group. If either FRAX >15% or sparse trabeculation was present, the RR was 2.6 (95% CI: 1.7-4.1) in the younger group and 15.7 (95% CI: 3.9-6.4) in the older group. We concluded that FRAX >15%, without BMD measurements, was an effective fracture predictor, and mandibular sparse trabeculation had a substantial additive effect. Together, FRAX plus mandibular sparse trabeculation predicts major osteoporotic fractures to approximately the same extent as does FRAX with BMD measurements.

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