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Clinical Predictors of Hip Fracture in Postmenopausal Women

A new algorithm accurately predicts 5-year risk; the next step is to test its clinical utility prospectively.

Several clinical factors are associated with an increased risk for hip fracture, but their relative importance and the best way to assess them together are unknown. Investigators analyzed a mean of nearly 8 years of follow-up data from the Women’s Health Initiative for more than 90,000 subjects and 1132 hip fractures to develop a predictive algorithm based on common clinical factors. The algorithm was validated in a separate cohort of nearly 70,000 subjects (and 791 fractures) with similar follow-up.

Regression analysis revealed 11 readily available factors associated with increased fracture risk: increasing age, fair to poor self-reported health, relatively greater height, relatively lighter weight, any fracture after age 54, white race or ethnicity, sedentary lifestyle, current smoking, parental hip fracture, current corticosteroid use, and treatment for diabetes. The model was significantly predictive and more accurate than dual energy x-ray absorptiometry (DEXA) at widely varying levels of hip-fracture risk.

Comment: This model is potentially very helpful to clinicians, because by interactively weighing several readily available clinical factors, it could support decisions about bone-mineral density (BMD) screening or treatment for low BMD. A Web-based interactive calculator is available at http://hipcalculator.fhcrc.org. However, the algorithm must be evaluated prospectively before it can be used confidently in daily practice.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine December 11, 2007

Citation(s):

Robbins J et al. Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 2007 Nov 28; 298:2389.

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