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Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study.
University of Gothenburg, Sweden;Region Kronoberg, Sweden.
Sahlgrenska University Hospital, Sweden.
Region Kronoberg, Sweden.
Region Kronoberg, Sweden.
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2010 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 11, p. 1-11, article id 55Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD) technique regarding hip and fragility fracture risk among elderly women.

METHODS: In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL) and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA) technique.

RESULTS: Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis) among 285 women; 60% having heel BMD <or= -2.5 SD. The 4-item FRAMO (Fracture and Mortality) Index combined the clinical risk factors age >or=80 years, weight <60 kg, prior fragility fracture, and impaired rise-up ability. Women having 2-4 risk factors showed odds ratio (OR) for hip fracture of 5.9 and fragility fracture of 4.4. High risk group hip fracture risk was 2.8% annually compared to 0.5% for the low risk majority (69%). Heel BMD showed hip fracture OR of 3.1 and fragility fracture OR of 2.6 per SD decrease. For 30 DXA assessed participants mean hip BMD at -2.5 SD level corresponded to a lower BMD at the heel. Five of seven hip fractures occurred within a small risk group of 32 women, identified by high FRAMO Index + prior fragility fracture + heel T-score <or=-3.5 SD.

CONCLUSIONS: In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%). These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

Place, publisher, year, edition, pages
BioMed Central, 2010. Vol. 11, p. 1-11, article id 55
National Category
Orthopaedics
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-81241DOI: 10.1186/1471-2474-11-55ISI: 000276443100001PubMedID: 20334634OAI: oai:DiVA.org:lnu-81241DiVA, id: diva2:1298092
Available from: 2019-03-21 Created: 2019-03-21 Last updated: 2019-04-16Bibliographically approved

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Thulesius, Hans

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