QJM Advance Access originally published online on September 23, 2006
QJM 2006 99(10):673-682; doi:10.1093/qjmed/hcl094
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A simple clinical score for estimating the long-term risk of fracture in post-menopausal women
From the 1Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands, 2MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK,3Department of Rheumatology, University Hospital, Maastricht, Netherlands, 4Limburg University Center, Diepenbeek, Belgium, and 5Centre for Metabolic Bone Disease (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, UK
Address correspondence to Professor C. Cooper, Professor of Rheumatology and Director, MRC Epidemiology Resource Centre, Southampton General Hospital, Southampton SO16 6YD. email: cc{at}mrc.soton.ac.uk
Received 3 March 2006 and in revised form 26 May 2006
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.