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Osteoporosis is a systemic skeletal disease characterized by low bone mass and bone structural deterioration that may result in fragility fractures. Use of bone imaging modalities to accurately predict fragility fractures is always an important issue, yet the current gold standard of dual‐energy X‐ray absorptiometry (DXA) for diagnosis of osteoporosis cannot fully satisfy this purpose. The latest high‐resolution peripheral quantitative computed tomography (HR‐pQCT) is a three‐dimensional (3D) imaging device to measure not only volumetric bone density, but also the bone microarchitecture in a noninvasive manner that may provide a better fracture prediction power. This systematic review and meta‐analysis was designed to investigate which HR‐pQCT parameters at the distal radius and/or distal tibia could best predict fragility fractures. A systematic literature search was conducted in Embase, PubMed, and Web of Science with relevant keywords by two independent reviewers. Original clinical studies using HR‐pQCT to predict fragility fractures with available full text in English were included. Information was extracted from the included studies for further review. In total, 25 articles were included for the systematic review, and 16 articles for meta‐analysis. HR‐pQCT was shown to significantly predict incident fractures and/or major osteoporotic fractures (MOFs). Of all the HR‐pQCT parameters, our meta‐analysis revealed that cortical volumetric bone mineral density (Ct.vBMD), trabecular thickness (Tb.Th), and stiffness were better predictors. Meanwhile, HR‐pQCT parameters indicated better performance in predicting MOFs than incident fractures. Between the two standard measurement sites of HR‐pQCT, the non‐weight‐bearing distal radius was a more preferable site than distal tibia for fracture prediction. Furthermore, most of the included studies were white‐based, whereas very few studies were from Asia or South America. These regions should build up their densitometric databases and conduct related prediction studies. It is expected that HR‐pQCT can be used widely for the diagnosis of osteoporosis and prediction of future fragility fractures. © 2021 The Authors.  Journal of Bone and Mineral Research  published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Best Performance Parameters of HR‐pQCT to Predict Fragility Fracture: Systematic Review and Meta‐Analysis