title: Validation of the Cummings' risk score; how well does it identify women with high risk of hip fracture: the Tromsø Study.
abstract: OBJECTIVE
  We examined a two-step case-finding strategy where the Cummings' risk score (NEJM 1995) was applied in a population-based setting together with bone mineral density (BMD) measurements in order to validate its ability to identify women with high risk of hip fracture.
  
  
  METHODS
  All Tromsø women aged between 65 and 74 were invited to the Tromsø Osteoporosis Study (TROST) together with a 5% random sample of women aged 75-84 years (n = 1410). All had forearm BMD measurements in 1994/95 and were followed for 5 years with respect to first hip fracture. A risk score was constructed matching the Cummings score as closely as possible.
  
  
  RESULTS
  In all 759, 578 and 73 women had 0-2, 3-4 and 5+ risk factors, respectively. Women with 5+ risk factors had a 5-year hip fracture risk of 11% (95% confidence interval (CI) 3.7-18.2%). BMD screening applied to these women identified 74% of them as osteoporotic and 19% as osteopenic with, respectively, 5-year hip fracture risk of 13% and 7.1%.
  
  
  CONCLUSIONS
  In a population different from the one the score was generated in, this simple risk score identifies a group of women with high risk of hip fractures. With no additional BMD measurements, those high-risk women could benefit from early intervention measures.
authors.affiliation: Institute of Community Medicine, University of Tromsø, 9037, Tromsø, Norway. Luai.Awad@ism.uit.no
authors.forename: Luai A
authors.initials: LA
authors.lastname: Ahmed
authors.forename: Henrik
authors.initials: H
authors.lastname: Schirmer
authors.forename: Vinjar
authors.initials: V
authors.lastname: Fønnebø
authors.forename: Ragnar M
authors.initials: RM
authors.lastname: Joakimsen
authors.forename: Gro K
authors.initials: GK
authors.lastname: Berntsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D015519:Bone Density / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000503:physiopathology; D011897:Random Allocation; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors