A simple clinical score for estimating the long-term risk of fracture in post-menopausal women.
BACKGROUND
Simple tools are needed to identify patients at high risk of fracture.


OBJECTIVE
To develop a simple clinical tool for assessing 5-year risk of fracture.


METHODS
Cohort study.


METHODS
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.


RESULTS
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.


CONCLUSIONS
This risk score predicts the long-term risk of fracture, and could be used for targeting patients for further investigation, such as bone densitometry.
van Staa
T P
TP
Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
Geusens
P
P
Kanis
J A
JA
Leufkens
H G M
HG
Gehlbach
S
S
Cooper
C
C
D000058:Accidental Falls; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008593:Menopause; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D006113:United Kingdom / Q000453:epidemiology