Evaluation of a Hip Fracture Risk Score for Assessing Elderly Women: The Melton Osteoporotic Fracture (MOF) Study

Abstract

Risk assessment for osteoporotic fracture within a primary care context, in old age, has received little attention. We aimed to develop such a risk score and assess its feasibility and validity. This was a 100% population-based, prospective cohort study, with a minimum 5 1/2 year follow-up among women aged 70 years and over, set in a large single general practice in Melton Mowbray, Leicestershire, UK. The main outcome measures were hip fracture, death and migration. Baseline measures included calcaneal broadband ultrasound attenuation (BUA), reported falls, balance, previous fracture history, medical problems, visual acuity, foot problems, body size, lifestyle factors and cognitive impairment. Seventy percent of the sample (1289) participated, including those in residential accommodation. Independent predictors of hip fracture over 3 years were low weight, kyphosis, poor circulation in the foot, epilepsy, short-term use of steroids and poor trunk maneuver. Using the highest tertile, a risk score based on these variables identified 84% (95% CI: 70% to 98%) of the hip fractures with a specificity of 68% (95% CI: 65% to 71%). BUA did not independently predict hip fracture in women of this age group. This study shows that a combination of readily obtained risk factors can identify elderly women who will sustain a hip fracture in the next 3 years more accurately than bone measurements alone in younger women. It also suggests that a risk score approach to universal assessment in the elderly is a feasible proposition in the primary care setting.

Utility of medical and drug history in fracture risk prediction among men and women

“…2,6,15,17 However, in a large epidemiological study of hip fracture contrasting risk factors between men and women, the associations with chronic medical disorders, physical activity, and cigarette smoking were generally similar for both genders. 18 This finding is consistent with the results of a previous British case-control study of hip fracture.…”

“…2,3 Our results are comparable to other published reports. In the Melton Mowbray Osteoporotic Fracture Study, 17 it was found that a combination of readily obtained risk factors was capable of identifying elderly women who later sustained a hip fracture. These included weight, poor trunk maneuver, epilepsy, kyphosis, poor circulation of the foot, and short-term corticosteroid use.…”

“…The area under the ROC curve in their analysis was 82%. 17 The Rotterdam Study 3 estimated an area under the ROC curve of 83% for hip fracture prediction based on age, gender, weight, height, use of a walking aid, and cigarette smoking. The corresponding figure was 71% in the Study of Osteoporotic Fractures, where the risk score utilized age, weight, fracture history, maternal fracture history, use of arms to stand up from a chair, and cigarette smoking.…”

Validation of a 4-Item Score Predicting Hip Fracture and Mortality Risk Among Elderly Women

“…5,10 Despite the use of only 4 clinical risk factors applied in a strict binary fashion in our FRAMO Index, its sensitivity and specifi city for 2-year hip fracture incidence were on par with those of previous studies with more complicated risk scoring. 5,8,11 Similar risk factors have been used in other studies, in which scores for predicting the risk of hip fracture within 3, 4, or 5 years were created. 4,5,11 In those studies, however, the variables of age or body weight were weighted, and a history of any type of fracture after age of 50 was used instead.…”

“…4,9,10 Many individuals who have an elevated risk of hip fracture might be identifi ed by clinical risk factors alone. 4,5,11 Previously described risk factor models for hip fracture are fairly complicated, requiring several weighted variables. Six clinical risk factors (2 weighted) and BMD assessment predicted fractures in the Study of Osteoporotic Fractures (SOF), and this risk factor combination was validated in another elderly community-based female population, the European Patent Information and Document Service (EPIDOS) fracture study.…”