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Article History

Received: 3 April 2025

Accepted: 15 June 2025

First Online: 23 August 2025

Declarations

:

: All individual cohorts with candidate risk factors available have been approved by their local ethics committees, and informed consent has been obtained from all study participants. General ethics approval for the use of all cohorts is also given by the University of Sheffield. This study does not contain any original studies with human participants or animals performed by any of the authors. Participant data are stored in coded, de-identified form. Only summary statistics and aggregate data are published, not allowing for the identification of individual study participants.

: JA Kanis led the team that developed FRAX as director of the WHO Collaborating Centre for Metabolic Bone Diseases; he is a director of Osteoporosis Research Ltd., which maintains FRAX.EV McCloskey, WD Leslie, M. Lorentzon, NC Harvey, M. Schini, E. Liu, L. Vandenput, and H. Johansson are members of the FRAX team. JA Kanis, NC Harvey, and EV McCloskey are members of the advisory body of the National Osteoporosis Guideline Group. He is a director of Osteoporosis Research Ltd., which maintains FRAX.KE Akesson has no financial interest related to FRAX and chaired the National SALAR Group for Person-Centered Care Pathway Osteoporosis.FA Anderson led the team that developed GLOW while being the director of the Center for Outcomes Research at the University of Massachusetts Medical School; he has no financial interest in FRAX.R. Azagra-Ledesma has received funding for research from Instituto Carlos III of Spanish Ministry of Health, IDIAP Jordi Gol of Catalan Government, and from Scientific Societies SEMFYC and SEIOMM.CL Bager is employed at Nordic Bioscience and owns stock in Nordic Bioscience. She declares no competing interests in relation to this work.HA Bischoff-Ferrari has no financial interest in FRAX. For the DO-HEALTH trial cohort, Prof. Bischoff-Ferrari reports independent and investigator-initiated grants from the European Commission Framework 7 Research Program, from the University of Zurich, from NESTEC, from Pfizer Consumer Healthcare, from Streuli Pharma, plus non-financial support from DNP. For the study cohort extension, she reports independent and investigator-initiated grants from Pfizer and Vifor. Further, Prof. Bischoff-Ferrari reports non-financial support from Roche Diagnostics and personal fees from Wild, Sandoz, Pfizer, Vifor, Mylan, Roche, and Meda Pharma, outside the submitted work with regard to speaker fees and travel fees.JR Center has received honoraria for speaking at educational meetings and for advisory boards from Amgen and honoraria for an advisory board from Bayer, all unrelated to this work.R. Chapurlat has no financial interest in FRAX. He has received grant funding from Amgen, UCB, Chugai, MSD, Mylan, and Medac. He has received honoraria from Amgen, UCB, Chugai, Galapagos, Biocon, AbbVie, Haoma Medica, Pfizer, Amolyt, MSD, Lilly, BMS, Novartis, Arrow, PKMed, Kyowa-Kirin, and Sanofi.C. Christiansen owns stock in Nordic Bioscience. He declares no competing interests in relation to this work.C. Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB.JAP da Silva has no financial interest in FRAX and reports personal fees from Amgen and Fresenius-Kabi, all outside the submitted work.A. Diez-Perez reports personal fees from Theramex and owns shares of Active Life Scientific, all outside the submitted work.JA Eisman declares consulting and research support from Actavis, Amgen, Aspen, Lilly, Merck Sharp and Dohme, Novartis, Sanofi-Aventis, Servier, and Theramex.PJM Elders has no financial interest in FRAX. PJM Elders reports support for the SOS study by Stichting Achmea Gezondheidszorg, Achmea, and VGZ zorgverzekeraar. Additional support was given by the Stichting Artsenlaboratorium en Trombosedienst. Outside the submitted work, she did receive independent investigator-driven grants from ZonMw, the Netherlands; de Hartstichting, the Netherlands; the European Foundation for the Study of Diabetes, Amgen, the Netherlands; TEVA, the Netherlands; and Takeda, the Netherlands.CC Gluer reports honoraria and research support from AgNovos, Amgen, Osteolabs, and UCB unrelated to this work.NC Harvey has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Radius Health, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Theramex, and Internis Pharma.DP Kiel has no financial interest in FRAX but has received support for his work in the Framingham Study over the past 32 years from the National Institutes of Health, AstraZeneca, Merck, Amgen, and Radius Health.MA Kotowicz has received funding from the National Health and Medical Research Council (NHMRC) Australia, the Medical Research Future Fund (MRFF) Australia, and Amgen. He has served on advisory boards for Amgen Australia, Novartis, and Eli Lilly—all unrelated to this work—and is the Director of the Geelong Bone Densitometry Service.M. Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma, and UCB Pharma, and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma, Parexel International, and Consilient Health, all outside the presented work.EV McCloskey has received consultancy/lecture fees/grant funding/honoraria from AgNovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, Gilead, GSK, Hologic, Internis, Lilly, Merck, Novartis, ObsEva, Pfizer, Radius Health, Redx Oncology, Roche, Sanofi Aventis, Theramex, UCB, ViiV, Warner Chilcott, and I3 Innovus, all outside the submitted work.C. Ohlsson is listed as a coinventor on two patent applications regarding probiotics in osteoporosis treatment.TW O’Neill reports honoraria from UCB unrelated to this work.ES Orwoll reports consulting fees from Angios, Biocon, Radius, and Bayer.JA Pasco has received funding from the National Health and Medical Research Council (NHMRC) Australia, the Medical Research Future Fund (MRFF), Australia, and Amgen, all unrelated to this work.M. Schini received funding for her fellowship from the Medical Research Council Centre of Excellence for Musculoskeletal Ageing, from the Osteoporosis 2000 support group, and from Roche Diagnostics, and honoraria from MA Health care and Kyowa Kirin—all unrelated to this work.KMA Swart is an employee of the PHARMO Institute for Drug Outcomes Research. This independent research institute performs financially supported studies for the government, related healthcare authorities, and several pharmaceutical companies.NC Wright sits on the Board of Trustees of the US Bone Health and Osteoporosis Foundation and has received consulting fees from Radius and ArgenX.M. Zwart has received research funding from national societies (SEMFYC and SEIOMM).C. Beaudart, E. Biver, O. Bruyere, JA Cauley, CJ Crandall, SR Cummings, B. Dawson-Hughes, AB Dufour, S. Ferrari, Y. Fujita, S. Fujiwara, I. Goldshtein, D. Goltzman, V. Gudnason, J. Hall, D. Hans, M. Hoff, RJ Hollick, M. Huisman, M. Iki, S. Ish-Shalom, H. Johansson, G. Jones, MK Karlsson, S. Khosla, W–P Koh, F. Koromani, H. Kroger, T. Kwok, O. Lamy, A. Langhammer, B. Larijani, WD Leslie, K. Lippuner, E. Liu, FEA McGuigan, D. Mellstrom, T. Merlijn, T. Nguyen, A. Nordstrom, P. Nordstrom, B. Obermayer-Pietsch, F. Rivadeneira, A-M Schott, EJ Shiroma, K. Siggeirsdottir, EM Simonsick, E. Sornay-Rendu, R. Sund, P. Szulc, J. Tamaki, DJ Torgerson, L. Vandenput, NM van Schoor, TP van Staa, J. Vila, N. Yoshimura, and MC Zillikens declare no competing interests in relation to this work.