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

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Abstract
Background: Simple tools are needed to identify patients at high risk of fracture. Aim: To develop a simple clinical tool for assessing 5-year risk of fracture. Design: 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 ⩾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. Discussion: This risk score predicts the long-term risk of fracture, and could be used for targeting patients for further investigation, such as bone densitometry.