Fracture risk tools performance and potential use in systemic lupus erythematosus
Authors' conclusion
In SLE, DeFRA outperforms FRAX in detecting vertebral fractures and offers a clinically efficient threshold for guiding targeted VFA
Study context
- Population
- Patients with systemic lupus erythematosus (SLE) who underwent DXA with vertebral fracture assessment (VFA); vertebral fractures confirmed by radiography
- Participants
- 106 patients
- Comparison
- DeFRA vs FRAX for 10-year major osteoporotic fracture probability
- Primary endpoint
- Discrimination (AUC) for newly detected vertebral fractures
Methodological detailsdiagnostic accuracy study, multicentre, ROC curves and DeLong's test, 2000 bootstrap resamples with out-of-bag evaluation
- Diagnostic accuracy study
- Multicentre
- ROC curves and DeLong's test
- 2000 bootstrap resamples with out-of-bag evaluation
Primary result
As reported in the abstract
Newly detected vertebral fractures, AUC
| Group | AUC |
|---|---|
| DeFRA | 0.834 (95% CI 0.725 to 0.944) |
| FRAX | 0.681 (95% CI 0.495 to 0.867) |
AUC
DeFRA0.834 (95% CI 0.725 to 0.944)
FRAX0.681 (95% CI 0.495 to 0.867)
- DeFRA vs FRAX: P = 0.022
Further findings
| Outcome | DeFRA ≥20% | FRAX ≥20% | DeFRA ≥15% |
|---|---|---|---|
| Detection of newly detected vertebral fractures at operational thresholds | 9/15 | 7 events | 10/15 |
| NNS | 1.78 | — not stated in the abstract | 2.0 |
— not stated in the abstract
- Detection of newly detected vertebral fractures at operational thresholds: NNS=1/PPV
Detection of newly detected vertebral fractures at operational thresholds
- Lowering cut-off to DeFRA ≥15% increased sensitivity without loss of specificity
Any vertebral fracture, discrimination (AUC)
- Similar results to newly detected fractures (DeFRA vs FRAX), AUC
- 0.902 vs 0.770; p=0.013
Bootstrap validation (2000 resamples, out-of-bag)
- Bootstrap validation confirmed the robustness of rank ordering
Original publication
Fracture risk tools performance and potential use in systemic lupus erythematosus. Lupus Sci Med. Published 9 February 2026. doi:10.
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