骨質疏鬆症及其相關脆弱性骨折已成為高齡社會重要公共衛生議題。然而，目前骨質疏鬆篩檢工具、骨折風險評估模型及本土化驗證研究仍存在不足。本研究旨在整合骨質疏鬆篩檢、骨折風險評估與長期追蹤驗證成果，建立台灣骨質疏鬆預測與骨折風險評估計算工具（Taiwan Osteoporosis Prediction and Fracture Assessment Calculation Tool, TOPFACT）之理論基礎。
本研究整合三項互補的研究。第一項研究利用台灣骨質疏鬆調查資料庫分析FRAX各風險因子對骨折風險之相對貢獻，並建立簡化模型。第二項研究使用兩個台灣社區世代資料驗證OSTA、OSTAi及MOSTAi之篩檢效能，並建立性別及年齡分層之最佳切點。第三項研究結合2009–2010年社區世代資料與全民健康保險資料庫，完成10年追蹤，驗證台灣版FRAX模型之校準度、鑑別能力及資料導向切點。
本研究結果支持採用多階段、風險分層架構來預測骨質疏鬆症和骨折的風險。在社區層面，OSTAi（切點<-1）和MOSTAi（切點<=11）可作為第一線非侵入性篩檢工具，用於識別可能需要進一步評估的個體。隨後，使用雙能量X射線吸收法之骨密度數值計算FRAX（無論是否結合骨密度）的風險值，並進行骨折風險分層，以確定後續的照護和治療決策，而在臨床使用上，FRAX之主要骨鬆性骨折建議切點範圍為9.0-9.5，而髖骨骨折的切點範圍為4.0-4.5。不論在FRAX十年驗證或公式解構上，年齡、性別和過往骨折史始終是骨折風險的主要預測因素，構成TOPFACT架構的預測工具核心變數。
綜合以上結果，以三階段、風險分層設計建立出台灣本土的骨折風險預測公式TOPFACT。透過將骨質疏鬆症的管理模式從基於診斷的概念轉變為基於絕對骨折風險的方法，將骨折預防工作向前推進至中年。除了臨床應用之外，該架構或可融入至國民健康署成人預防保健服務中，並且與國際骨質疏鬆症基金會和中華民國骨質疏鬆症學會不斷發展的預防模式相一致，由「Stop at One」邁向「Stop at Zero」的預防骨鬆與首次骨折新思維。

Osteoporosis and fragility fractures represent major public health challenges in aging societies. However, gaps remain in osteoporosis screening, fracture risk assessment, and long-term validation of risk prediction models in Asian populations. This dissertation aimed to integrate osteoporosis screening, fracture risk prediction, and longitudinal validation to establish the scientific foundation of the Taiwan Osteoporosis Prediction and Fracture Assessment Calculation Tool (TOPFACT).
This study integrates three complementary studies. Study 1 decomposed the Fracture Risk Assessment Tool (FRAX®) using a nationwide osteoporosis survey and developed simplified fracture prediction models. Study 2 validated osteoporosis self-assessment tools (OSTA, OSTAi, and MOSTAi) and established age- and sex-specific screening thresholds. Study 3 linked community-based cohort data with the National Health Insurance Research Database to perform a complete 10-year validation of Taiwan-specific FRAX models, including calibration, discrimination, and threshold analyses.
The results support a multistage, risk-stratified framework for osteoporosis and fracture prevention. At the community level, OSTAi (cutoff point <-1) and MOSTAi (cutoff point <=11) can serve as first-line non-invasive screening tools to identify individuals who may require further evaluation. Subsequently, FRAX (whatever with/without BMD) are calculated using dual-energy X-ray absorptiometry and fracture risk stratification is performed to determine subsequent care and treatment decisions. In clinical use, the recommended cutoff point range for FRAX in major osteoporotic fractures is 9.0–9.5, while the cutoff point range for hip fractures is 4.0–4.5. Regardless of the 10-year validation or formula deconstruction of FRAX, age, sex, and previous fracture remain the main predictors of fracture risk, constituting the core variables of the TOPFACT framework's predictive tools.
This dissertation integrates osteoporosis screening, fracture risk assessment, and long-term validation into a unified framework and provides the preliminary fracture prediction model called as TOPFACT. The findings support a stepwise strategy for community-based osteoporosis screening and fracture risk stratification and provide Taiwan-specific data-driven thresholds to inform future clinical and public health decision-making. This TOPFACT framework could also potentially be integrated into the Health Promotion Administration’s adult preventive health services. This would align with the evolving prevention models championed by the International Osteoporosis Foundation (IOF) and the Taiwanese Osteoporosis Association (TOA), reflecting a new paradigm in osteoporosis management and fracture prevention: transitioning from 'Stop at One' to 'Stop at Zero.

1. Johnell O, Kanis JA. Epidemiology of osteoporotic fractures. Osteoporosis International 2005; 16(2): S3–S7.
2. WHO Scientific Group. Assessment of osteoporosis at the primary health-care level. WHO Scientific Group Technical Report 2007.
3. Mafi Golchin M, Heidari L, Ghaderian SMH, Akhavan-Niaki H. Osteoporosis: A Silent Disease with Complex Genetic Contribution. Journal of Genetics and Genomics 2016; 43(2): 49–61.
4. Wu C-H, McCloskey EV, Lee JK, et al. Consensus of Official Position of IOF/ISCD FRAX Initiatives in Asia-Pacific Region. Journal of Clinical Densitometry 2014; 17(1): 150–5.
5. Lee M-T, Fu S-H, Hsu C-C, et al. Epidemiology and clinical impact of osteoporosis in Taiwan: A 12-year trend of a nationwide population-based study. Journal of the Formosan Medical Association 2023; 122: S21–S35.
6. Koh LKH, Sedrine WB, Torralba TP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int 2001; 12(8): 699–705.
7. Su F-M, Liu D-H, Chen J-F, et al. Development and Validation of an Osteoporosis Self-Assessment Tool for Taiwan (OSTAi) Postmenopausal Women-A Sub-Study of the Taiwan OsteoPorosis Survey (TOPS). PLoS One 2015; 10(6): e0130716.
8. Liu D-H, Hsu C-Y, Wu P-C, et al. Simple Self-Assessment Tool to Predict Osteoporosis in Taiwanese Men. Front Med (Lausanne) 2021; 8: 713535.
9. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX® and its applications to clinical practice. Bone 2009; 44(5): 734–43.
10. Centre for Metabolic Bone Diseases University of Sheffield. FRAX®Fracture Risk Assessment Tool. https://frax.shef.ac.uk/FRAX/index.aspx (accessed Oct 2024 2024).
11. Osteoporosis Research Ltd. FRAXplus®. https://www.fraxplus.org/ (accessed Oct 2024 2024).
12. Vandenput L, Johansson H, McCloskey EV, et al. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporosis International 2022; 33(10): 2103–36.
13. Leslie WD, Morin SN, Lix LM, et al. Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study. Osteoporosis International 2021; 32(1): 113–22.
14. Wu Q, Jung J. Uncovering Racial and Genetic Disparities in FRAX Performance for Fracture Risk Assessment in Postmenopausal Women. Journal of Bone and Mineral Research 2025: zjaf160.
15. Fuleihan GE-H, Chakhtoura M, Cauley JA, Chamoun N. Worldwide Fracture Prediction. Journal of Clinical Densitometry 2017; 20(3): 397–424.
16. Kanis JA, Cooper C, Dawson-Hughes B, et al. FRAX and ethnicity. Osteoporosis International 2020; 31(11): 2063–7.
17. Liu I-T, Liang F-W, Li C-C, et al. Validation of the Taiwan FRAX® calculator for the prediction of fracture risk. Archives of Osteoporosis 2022; 17(1): 27.
18. Hsieh C-Y, Su C-C, Shao S-C, et al. Taiwan's National Health Insurance Research Database: past and future. Clinical Epidemiology 2019; 11: 349–58.
19. National Health Insurance Administration. National Health Insurance Annual Report 2024-2025. 2024.
20. Akesson K, Marsh D, Mitchell PJ, et al. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporosis International 2013; 24(8): 2135–52.
21. Tai T-W, Huang C-F, Huang H-K, et al. Clinical practice guidelines for the prevention and treatment of osteoporosis in Taiwan: 2022 update. Journal of the Formosan Medical Association 2023; 122: S4–S13.
22. Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. The American Journal of Medicine 1993; 94(6): 646–50.
23. Genant HK, Engelke K, Fuerst T, et al. Noninvasive assessment of bone mineral and structure: state of the art. Journal of Bone and Mineral Research 1996; 11(6): 707–30.
24. Blake GM, Patel R, Knapp KM, Fogelman I. Does the combination of two BMD measurements improve fracture discrimination? Journal of Bone and Mineral Research 2003; 18(11): 1955–63.
25. Mazess R, Collick B, Trempe J, Barden H, Hanson J. Performance evaluation of a dual-energy X-ray bone densitometer. Calcified Tissue International 1989; 44: 228–32.
26. Hendrickx G, Boudin E, Van Hul W. A look behind the scenes: the risk and pathogenesis of primary osteoporosis. Nature Reviews Rheumatology 2015; 11(8): 462–74.
27. WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal oseteoporosis. WHO Technical Report Series 1994; 843.
28. Xiao PL, Cui AY, Hsu CJ, et al. Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: a systematic review and meta-analysis. Osteoporosis International 2022; 33(10): 2137–53.
29. International Osteoporosis Foundation. About Osteoporosis: Risk Factors. https://www.osteoporosis.foundation/patients/about-osteoporosis/risk-factors (accessed Oct 2024.
30. International Osteoporosis Foundation. Epidemiology Of Osteoporosis And Fragility Fractures. https://www.osteoporosis.foundation/facts-statistics/epidemiology-of-osteoporosis-and-fragility-fractures (accessed Oct 2024.
31. Wu A-M, Bisignano C, James SL, et al. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity 2021; 2(9): e580–e92.
32. Ström O, Borgström F, Kanis JA, et al. Osteoporosis: Burden, health care provision and opportunities in the EU. Archives of Osteoporosis 2011; 6(1-2): 59–155.
33. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of Mortality Following Clinical Fractures. Osteoporosis International 2000; 11(7): 556–61.
34. Johansson C, Black D, Johnell O, Odén A, Mellström D. Bone Mineral Density Is a Predictor of Survival. Calcified Tissue International 1998; 63(3): 190–6.
35. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, III LJM. Population-Based Study of Survival after Osteoporotic Fractures. American Journal of Epidemiology 1993; 137(9): 1001–5.
36. Leibson CL, Tosteson ANA, Gabriel SE, Ransom JE, Melton Iii LJ. Mortality, Disability, and Nursing Home Use for Persons with and without Hip Fracture: A Population-Based Study. Journal of the American Geriatrics Society 2002; 50(10): 1644–50.
37. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone 1995; 17(5, Supplement 1): S505–S11.
38. Johnell O, Oden A, Caulin F, Kanis JA. Acute and Long-Term Increase in Fracture Risk after Hospitalization for Vertebral Fracture. Osteoporosis International 2001; 12(3): 207–14.
39. World Health Organization. The World health report: 2004: changing history: World Health Organization; 2004.
40. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International 2006; 17(12): 1726–33.
41. Borgström F, Karlsson L, Ortsäter G, et al. Fragility fractures in Europe: burden, management and opportunities. Archives of Osteoporosis 2020; 15(1): 59.
42. 中華民國骨質疏鬆症學會. 25週年紀念專刊: 中華民國骨質疏鬆症學會; 2022.
43. 蕭正光, 蔡克嵩. 臺灣地區骨質疏鬆症之流行現況. 國人骨質疏鬆症防治指引. 臺北: 行政院衛生署; 1997: 6–10.
44. 蔡益堅, 何彥瑤. 台灣地區老年髖骨骨折罹病天數及經濟成本: 臺灣省家庭計畫研究所; 1994.
45. Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of osteoporosis in patients with fragility fractures. Canadian Medical Association Journal 2000; 163(7): 819–22.
46. Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR. Recognition of vertebral fracture in a clinical setting. Osteoporosis International 2000; 11(7): 577–82.
47. International Osteoporosis Foundation. Facts & Statistics. https://www.osteoporosis.foundation/facts-statistics (accessed Oct 2024.
48. International Osteoporosis Foundation. Fracture Liaison Services. https://www.osteoporosis.foundation/our-network (accessed Oct 2024.
49. Chen F-P, Huang T-S, Fu T-S, Sun C-C, Chao A-S, Tsai T-L. Secular trends in incidence of osteoporosis in Taiwan: A nationwide population-based study. Biomedical Journal 2018; 41(5): 314–20.
50. Lu Y-C, Lin YC, Lin Y-K, et al. Prevalence of Osteoporosis and Low Bone Mass in Older Chinese Population Based on Bone Mineral Density at Multiple Skeletal Sites. Scientific Reports 2016; 6(1): 25206.
51. Yang N-P, Deng C-Y, Chou Y-J, et al. Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy 2006; 75(3): 329–37.
52. Chie W-C, Yang R-S, Liu J-P, Tsai K-S. High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporosis International 2004; 15(12): 998–1002.
53. Shao C-J, Hsieh Y-H, Tsai C-H, Lai K-A. A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone 2009; 44(1): 125–9.
54. Tsai KS, Twu SJ, Chieng PU, Yang RS, Lee TK, the Geriatric Study Group ROC. Prevalence of Vertebral Fractures in Chinese Men and Women in Urban Taiwanese Communities. Calcified Tissue International 1996; 59(4): 249–53.
55. Chen YP, Chang WC, Wen TW, Chien PC, Huang SW, Kuo YJ. Multipronged Programmatic Strategy for Preventing Secondary Fracture and Facilitating Functional Recovery in Older Patients after Hip Fractures: Our Experience in Taipei Municipal Wanfang Hospital. Medicina (Kaunas) 2022; 58(7).
56. Soong YK, Tsai KS, Huang HY, et al. Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan. Osteoporosis International 2013; 24(2): 511–21.
57. Li Y, Tung K-K, Cho Y-C, Lin S-Y, Lee C-H, Chen C-H. Improved outcomes and reduced medical costs through multidisciplinary co-management protocol for geriatric proximal femur fractures: a one-year retrospective study. BMC Geriatrics 2022; 22(1): 318.
58. Huang C-F, Pan P-J, Chiang Y-H, Yang S-H. A Rehabilitation-Based Multidisciplinary Care Model Reduces Hip Fracture Mortality in Older Adults. Journal of Multidisciplinary Healthcare 2021; 14: 2741–7.
59. Chen J-S, Chen P-M, Lin C-Y, Chen R-F, Lee P-Y. Beneficial effects of bipolar hemiarthroplasty replacement and fosamax in the retrospective cohort study of refracture and mortality of hip fractured patients. Pak J Pharm Sci 2016; 29(3 Suppl): 1071–5.
60. Chang CB, Yang RS, Huang WJ, et al. Urban-rural differences in outcomes and management of vertebral fractures: A real-world observational study. Journal of the Formosan Medical Association 2022.
61. Weinstein L, Ullery B. Identification of at-risk women for osteoporosis screening. American Journal of Obstetrics and Gynecology 2000; 183(3): 547–9.
62. Nguyen TV, Center JR, Pocock NA, Eisman JA. Limited utility of clinical indices for the prediction of symptomatic fracture risk in postmenopausal women. Osteoporosis International 2004; 15(1): 49–55.
63. Haugeberg G, Ørstavik RE, Uhlig T, Falch JA, Halse JI, Kvien TK. Clinical decision rules in rheumatoid arthritis: do they identify patients at high risk for osteoporosis? Testing clinical criteria in a population based cohort of patients with rheumatoid arthritis recruited from the Oslo Rheumatoid Arthritis Register. Ann Rheum Dis 2002; 61(12): 1085–9.
64. National Osteoporosis Foundation. Physicians guide to prevention and treatment of osteoporosis. Excerpta Med 1998.
65. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. Canadian Medical Association Journal 2000; 162(9): 1289–94.
66. Sedrine WB, Chevallier T, Zegels B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecological endocrinology 2002; 16(3): 245–50.
67. Sirola J, Kröger H, Honkanen R, et al. Risk factors associated with peri- and postmenopausal bone loss: does HRT prevent weight loss-related bone loss? Osteoporosis International 2003; 14(1): 27–33.
68. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 1998; 4(1): 37–48.
69. Black DM. SOFSURF: A simple, useful risk factor system can identify the large majority of women with osteoporosis. Bone 1998; 23: S605.
70. Sedrine WB, Chevallier T, Zegels B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecological endocrinology 2002; 16(3): 245–50.
71. Adler RA, Tran MT, Petkov VI. Performance of the Osteoporosis Self-assessment Screening Tool for osteoporosis in American men. Mayo Clinic Proceedings 2003; 78(6): 723–7.
72. Kung AW, Ho AY, Sedrine WB, Reginster JY, Ross PD. Comparison of a simple clinical risk index and quantitative bone ultrasound for identifying women at increased risk of osteoporosis. Osteoporosis International 2003; 14(9): 716–21.
73. Sedrine WB, Broers P, Devogelaer J-P, et al. Interest of a prescreening questionnaire to reduce the cost of bone densitometry. Osteoporosis International 2002; 13(5): 434–42.
74. Mühlen DV, Lunde AV, Barrett-Connor E, Bettencourt R. Evaluation of the simple calculated osteoporosis risk estimation (SCORE) in older Caucasian women: the Rancho Bernardo study. Osteoporosis International 1999; 10(1): 79–84.
75. Leslie WD, Lix LM. Comparison between various fracture risk assessment tools. Osteoporosis International 2014; 25(1): 1–21.
76. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ : British Medical Journal 2012; 344: e3427.
77. ClinRisk Ltd. QFracture®-2016 risk calculator. https://qfracture.org/index.php (accessed Oct 2024 2024).
78. Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporosis International 2007; 18(8): 1109–17.
79. Garvan Institute of Medical Research. Bone Fracture Risk Calculator. https://www.garvan.org.au/research/bone-fracture-risk-calculator (accessed Oct 2024 2024).
80. Kanis JA, Johansson H, Harvey NC, McCloskey EV. A brief history of FRAX. Archives of Osteoporosis 2018; 13(1): 118.
81. Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International 2012; 23(9): 2239–56.
82. Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporosis International 2008; 19(10): 1431–44.
83. Black DM, Steinbuch M, Palermo L, et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporosis International 2001; 12(7): 519–28.
84. Henry MJ, Pasco JA, Sanders KM, Nicholson GC, Kotowicz MA. Fracture Risk (FRISK) Score: Geelong Osteoporosis Study. Radiology 2006; 241(1): 190–6.
85. Robbins J, Aragaki AK, Kooperberg C, et al. Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 2007; 298(20): 2389–98.
86. Pluijm SM, Koes B, de Laet C, et al. A simple risk score for the assessment of absolute fracture risk in general practice based on two longitudinal studies. Journal of Bone and Mineral Research 2009; 24(5): 768–74.
87. Henry MJ, Pasco JA, Merriman EN, et al. Fracture risk score and absolute risk of fracture. Radiology 2011; 259(2): 495–501.
88. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporosis International 2005; 16(6): 581–9.
89. Schott AM, Cormier C, Hans D, et al. How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study. Osteoporosis International 1998; 8: 247–54.
90. Cummings SR, Nevitt MC, Browner WS, et al. Risk Factors for Hip Fracture in White Women. New England Journal of Medicine 1995; 332(12): 767–73.
91. Sanders KM, Pasco JA, Ugoni AM, et al. The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. Journal of Bone and Mineral Research 1998; 13(8): 1337–42.
92. Sanders KM, Seeman E, Ugoni AM, et al. Age-and gender-specific rate of fractures in Australia: a population-based study. Osteoporosis International 1999; 10: 240–7.
93. Glüer CCD, Eastell R, Reid DM, et al. Association of Five Quantitative Ultrasound Devices and Bone Densitometry With Osteoporotic Vertebral Fractures in a Population‐Based Sample: The OPUS Study. Journal of Bone and Mineral Research 2004; 19(5): 782–93.
94. Bagger YZ, Tankó LB, Alexandersen P, Hansen HB, Qin G, Christiansen C. The long-term predictive value of bone mineral density measurements for fracture risk is independent of the site of measurement and the age at diagnosis: results from the Prospective Epidemiological Risk Factors study. Osteoporosis International 2006; 17(3): 471–7.
95. Neergaard JS, Dragsbæk K, Kehlet SN, et al. Cohort Profile: The Prospective Epidemiological Risk Factor (PERF) study. International Journal of Epidemiology 2017; 46(4): 1104–i.
96. Birks YF, Porthouse J, Addie C, et al. Randomized controlled trial of hip protectors among women living in the community. Osteoporosis International 2004; 15: 701–6.
97. Walley T, Mantgani A. The UK general practice research database. The Lancet 1997; 350(9084): 1097–9.
98. Krieg MA, Comuz J, Ruffieux C, Burckhardt P. Rôle des ultrasons osseux pour la prédiction du risque de fracture de la hanche chez la femme âgée de 70 ans ou plus: résultats de l'étude SEMOF et comparaison avec les données de la littérature: Ostéoporose. Rev Med Suisse Romande 2004; 124(2): 59–62.
99. Hays J, Hunt JR, Hubbell FA, et al. The Women's Health Initiative recruitment methods and results. Annals of Epidemiology 2003; 13(9): S18–S77.
100. Anderson GL, Manson J, Wallace R, et al. Implementation of the Women's Health Initiative study design. Annals of Epidemiology 2003; 13(9): S5–S17.
101. Yoshimura N, Takijiri T, Kinoshita H, et al. Characteristics and course of bone mineral densities among fast bone losers in a rural Japanese community: the Miyama Study. Osteoporosis International 2004; 15: 139–44.
102. Shao C-J, Hsieh Y-H, Tsai C-H, Lai K-A. A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone 2009; 44(1): 125–9.
103. Osteoporosis Research Ltd. FRAXplus® calculation tool. 2026. https://www.fraxplus.org/calculation-tool?country=26 (accessed May 31 2026).
104. Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporosis International 2007; 18(8): 1033–46.
105. Chan D-C, McCloskey EV, Chang C-B, et al. Establishing and evaluating FRAX® probability thresholds in Taiwan. Journal of the Formosan Medical Association 2017; 116(3): 161–8.
106. Liu I-T, Liang F-W, Wang S-T, Chang C-M, Lu T-H, Wu C-H. The effects of falls on the prediction of osteoporotic fractures: epidemiological cohort study. Archives of Osteoporosis 2021; 16(1): 110.
107. Yang J, Liao M, Wang Y, et al. Opportunistic osteoporosis screening using chest CT with artificial intelligence. Osteoporosis International 2022; 33(12): 2547–61.
108. Chen J-F, Yu S-F, Hsu C-Y, et al. The role of bone mineral density in therapeutic decision-making using the Fracture Risk Assessment Tool (FRAX): a sub-study of the Taiwan OsteoPorosis Survey (TOPS). Archives of Osteoporosis 2019; 14(1): 101.
109. Dawson-Hughes B, National Osteoporosis Foundation Guide Committee. A revised clinician’s guide to the prevention and treatment of osteoporosis. The Journal of Clinical Endocrinology & Metabolism 2008; 93(7): 2463–5.
110. Chang C-S, Chang Y-F, Liu P-Y, Chen C-Y, Tsai Y-S, Wu C-H. Smoking, habitual tea drinking and metabolic syndrome in elderly men living in rural community: the Tianliao old people (TOP) study 02. PLoS One 2012; 7(6): e38874.
111. Chang C-S, Chang Y-F, Wang M-W, et al. Inverse Relationship Between Central Obesity and Osteoporosis in Osteoporotic Drug Naive Elderly Females: The Tianliao Old People (TOP) Study. Journal of Clinical Densitometry 2013; 16(2): 204–11.
112. Wu C-H, Chen H-Y, Chang Y-F, et al. Osteoporosis and status of management in old males lived in rural community in Taiwan. OSTEOPOROSIS INTERNATIONAL; 2011: Springer Verlag; 2011. p. 314–.
113. 趙育箴, 陳全裕, 吳俊鋒, et al. 偏遠社區老年女性骨質疏鬆症盛行率與相關危險因子之研究. 台灣家庭醫學雜誌 2010; 20(2): 64–73.
114. Ou L-C, Sun Z-J, Chang Y-F, et al. Epidemiological Survey of Quantitative Ultrasound in Risk Assessment of Falls in Middle-Aged and Elderly People. PLoS One 2013; 8(8): e71053.
115. 林瑞模, 姚美雲, 唐建生, et al. 國內民眾社區骨質疏鬆篩檢結果正確性和知識、態度及行為調查. 2009.
116. Liu D-H, Cheng T-T, Su F-M, et al. Modified Male Osteoporosis Self-Assessment Tool for Taiwan (MOSTAi)-A Sub-Study of Taiwan OsteoPorosis Survey (TOPS). Osteoporosis and Sarcopenia 2015; 1(2): 135.
117. Newman ED, Olenginski TP, Perruquet JL, Hummel J, Indeck C, Wood GC. Using Mobile DXA to Improve Access to Osteoporosis Care: Unit Design, Program Development, Implementation, and Outcomes. Journal of Clinical Densitometry 2004; 7(1): 71–5.
118. Chien W-C, Lai C-H, Chung C-H, Lin C-H. A retrospective population-based data analyses of unintentional fall mortality and hospitalisation in Taiwan during 2005-2007. International Journal of Injury Control and Safety Promotion 2013; 20(1): 50–8.
119. Wei MY, Luster JE, Chan C-L, Min L. Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data. BMC Health Serv Res 2020; 20(1): 489.
120. Tai T-W, Hwang J-S, Li C-C, Hsu JC, Chang C-W, Wu C-H. The Impact of Various Anti-Osteoporosis Drugs on All-Cause Mortality After Hip Fractures: A Nationwide Population Study. Journal of Bone and Mineral Research 2022; 37(8): 1520–6.
121. Tai T-W, Tsai Y-L, Shih C-A, et al. Refracture risk and all-cause mortality after vertebral fragility fractures: Anti-osteoporotic medications matter. Journal of the Formosan Medical Association 2023; 122: S65–S73.
122. Chang H-J, Chang Y-F, Yang Y-C, et al. Epidemiological survey of falls and associated risk factors in old females in an aging community. Taiwan Geriatr Gerontol 2010; 5: 50–61.
123. Li C-C, Liu IT, Cheng T-T, et al. Decomposing and simplifying the Fracture Risk Assessment Tool-a module from the Taiwan-specific calculator. JBMR Plus 2024; 8(5): ziae039.
124. Writing Group for the ISCD Position Development Conference. Position statement: executive summary. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference. Journal of Clinical Densitometry 2004; 7(1): 7–12.
125. Hwang J-S, Chan D-C, Chen J-F, et al. Clinical practice guidelines for the prevention and treatment of osteoporosis in Taiwan: summary. Journal of Bone and Mineral Metabolism 2014; 32(1): 10–6.
126. Hsu Y-H, Li C-C, Liang F-W, et al. Reduced All-Cause Mortality With Bisphosphonates Among Post-Fracture Osteoporosis Patients: A Nationwide Study and Systematic Review. Clinical Pharmacology & Therapeutics 2022; 112(3): 711–9.
127. Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. Journal of the American Statistical Association 1999; 94(446): 496–509.
128. Ilich JZ. Another Impairment in Older Age: What Does Osteosarcopenic Obesity Syndrome Mean for Middle-Aged and Older Women? Journal of the American Medical Directors Association 2017; 18(8): 648–50.
129. Okyar Baş A, Güner Oytun M, Deniz O, et al. Ultrasonografically assessed osteosarcopenic obesity is associated with frailty in community-dwelling older adults. Nutrition 2022; 103-104: 111827.
130. Chen L-K, Hsiao F-Y, Akishita M, et al. A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update. Nature Aging 2025; 5(11): 2164–75.
131. Tseng S-C, Lien C-E, Lee C-H, et al. Clinical validation of a deep learning-based software for lumbar bone mineral density and t-score prediction from chest x-ray images. Diagnostics 2024; 14(12): 1208.