The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults. We included English-language, controlled or prospective cohort studies that enrolled US adults aged >40 years and reported tool performance predicting incident fractures within individual race and ethnicity groups for up to 10 years. From 4838 identified references, six reports met eligibility criteria, all in women. Just three, all from one study, included results in non-white individuals. In these three reports, non-white women experienced relatively few major osteoporotic fractures (MOFs), especially hip fractures, and risk thresholds for predicting fractures in non-white women were derived from risks in the overall, predominantly white study population. One report suggested the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) overestimated hip fracture similarly across race and ethnicity groups (black, Hispanic, American Indian, Asian, white) but overestimated MOF more in non-white than White women. However, these three reports were inconclusive regarding whether discrimination of FRAX or the Garvan calculator without BMD or of FRAX with BMD for MOF or hip fracture differed between white versus black women. This uncertainty was at least partly due to imprecise hip fracture estimates in black women. No reports examined whether ratios of observed to predicted hip fracture risks within each race or ethnicity group varied across levels of predicted hip fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

中文翻译：

---

按种族和民族划分的骨折风险评估工具的性能：ASBMR 骨折风险临床算法工作组的系统审查

美国骨与矿物质研究协会 (ASBMR) 专业实践委员会责成 ASBMR 骨折风险临床算法工作组审查现有基于种族和民族区分骨折风险的方法是否必要且有效的证据。为了帮助解决这些指控，我们进行了系统的文献综述，调查了计算器在预测美国中老年人的种族和民族内部和跨种族和族裔群体中发生骨折的性能。我们纳入了英语对照或前瞻性队列研究，这些研究招募了 40 岁以上的美国成年人，并报告了预测单个种族和民族群体内长达 10 年骨折事件的工具性能。从 4838 份已确定的参考文献中，有 6 份报告符合资格标准，且全部为女性。一项研究中只有三项包含非白人的结果。在这三份报告中，非白人女性经历的重大骨质疏松性骨折 (MOF) 相对较少，尤其是髋部骨折，预测非白人女性骨折的风险阈值来自于以白人为主的总体研究人群的风险。一份报告表明，不考虑骨密度​​ (BMD) 的骨折风险评估工具 (FRAX) 在不同种族和族裔群体（黑人、西班牙裔、美洲印第安人、亚洲人、白人）中同样高估了髋部骨折，但非白人女性的 MOF 高估程度高于白人女性。然而，这三份报告对于 FRAX 或不带 BMD 的 Garvan 计算器或带 BMD 的 FRAX 对 MOF 或髋部骨折的区分在白人与黑人女性之间是否存在差异尚无定论。这种不确定性至少部分是由于对黑人女性髋部骨折的不精确估计造成的。没有报告检查每个种族或族裔群体中观察到的髋部骨折风险与预测的髋部骨折风险之比是否因预测的髋部骨折风险水平而异。© 2023 作者。《Journal of Bone and Mineral Research》由 Wiley periodicals LLC 代表美国骨与矿物研究学会 (ASBMR) 出版。本文由美国政府雇员撰写，他们的作品在美国属于公共领域。