A simple clinical score for estimating the long- term risk of fracture in post-menopausal women

• Published in: QJM : An International Journal of Medicine 2006-10, Vol.99 (10), p.673-682
• Main Authors: VAN STAA, T. P, GEUSENS, P, KANIS, J. A, LEUFKENS, H. G. M, GEHLBACH, S, COOPER, C
• Format: Article
• Language: English
• Subjects: Accidental Falls; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Body Mass Index; Cohort Studies; Female; Fractures, Bone - epidemiology; Fractures, Bone - etiology; General aspects; Hip Fractures - epidemiology; Hip Fractures - etiology; Humans; Incidence; Medical sciences; Menopause; Middle Aged; Risk Assessment - methods; Risk Factors; Smoking - adverse effects; United Kingdom - epidemiology
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcl094

Simple tools are needed to identify patients at high risk of fracture. To develop a simple clinical tool for assessing 5-year risk of fracture. Cohort study. The study population consisted of all women aged 50+ included in the THIN Research Database (containing computerized medical records of UK general practices). Using Cox proportional hazards models, a risk score was initially estimated from age, body mass index, and clinical risk factors. The 5-year risk of fracture (survival function) was estimated for each score. The study population included 366 104 women aged > or = 50 years (mean follow-up 5.8 years). Of these, 6453 suffered a hip fracture. Several characteristics independently contributed to the fracture risk score (age, body mass index, fracture and fall history, previous diagnoses and use of medication). The 5-year risks for hip fracture for patients with total scores of 10, 30 and 50 were 0.3% (95%CI 0.3-0.4%), 2.2% (95%CI 2.1-2.2%), and 13.1% (95%CI 12.5-13.7%), respectively. A woman aged 65 years with low BMI and a history of both fracture and falling would have a hip fracture risk score of 37, with a corresponding 5-year risk for a hip fracture of 4.1% (4.0-4.2%). The risk score was validated and tested in another population (from GPRD), with a good concurrence between predicted and observed risks of fracture. This risk score predicts the long-term risk of fracture, and could be used for targeting patients for further investigation, such as bone densitometry.