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

Abstract

PURPOSE One in 4 Swedish women experiences a hip fracture, an event that has high concomitant morbidity and mortality. We developed and validated a clinical predictor of fracture and mortality risk, the Fracture and Mortality (FRAMO) Index. METHODSThis was a population-based prospective cohort study with a baseline questionnaire and 2-year outcomes of hip fracture, fragility fracture, and death. The questionnaire was sent to 1,498 women aged 70 years or older in 3 rural populations, asking them about their age, weight, height, mobility, previous fractures, smoking, medication use, and housing. Some women were also asked about previous vertebral radiographs. We defi ned 2 risk models before outcome data collection and subsequently renamed 1 model (age ≥80 years, weight <60 kg, previous fragility fracture, and the need to use arms to rise from the sitting position) the FRAMO Index. We used logistic regression analysis to study the association between the FRAMO Index and outcomes in all participants. RESULTSThe participation rate was 83% in this elderly female population (N = 1,248). The 63% of women with 0 to 1 risk factor had a 2-year hip fracture risk of 0.8% and mortality risk of 3.2%. In contrast, women with 2 to 4 risk factors had a 2-year hip fracture risk of 5.4% (odds ratio = 7.5; 95% confi dence interval, 3.0-18.4) and mortality risk of 23.7% (odds ratio = 9.5; 95% confi dence interval, 6.0-14.9). These differences remained signifi cant after adjustment for age as a continuous variable. Mortality increased with the number of risk factors. The proportion of women reporting previous vertebral fractures was higher among the group specifi cally questioned about vertebral radiographs (P <.001).CONCLUSIONS The FRAMO Index identifi ed the majority of women who experienced hip fractures during a 2-year follow-up, who might have been candidates for intensifi ed preventive measures. The FRAMO Index, based on 4 binary risk factors, would be practical for routine use in primary care. 2007;5:48-56. DOI: 10.1370/afm.602. Ann Fam Med INTRODUCTIONH ip fracture is an increasing problem worldwide.1 One in 4 Swedish women (23%) experiences a hip fracture during her lifetime, an event that is associated with 20% mortality within 1 year. 2,3 There are several methods for fracture prevention, although they are underused in routine health care.Combinations of low bone mineral density (BMD) with certain clinical risk factors are associated with an increased risk of hip fracture, 4-8 but low BMD alone is less predictive of fracture. 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 PR EDIC T ING HIP FR AC T UR EStudy of Osteoporotic Fractures (SOF), and this risk factor combination was validated in another elderly community-based female populatio...

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

“…16 Several other factors are known to increase the risk for hip fracture, such as advanced age, 17 region of the world, 18 quadriceps weakness, 19 low body mass index, postural instability, 20 previous fracture, 21 female sex, and history of parent's hip fracture. [22][23][24][25] Our study, similar to several previous studies, highlights the value of some of these risk factors in hip fracture risk stratification.…”

“…The Fracture and Mortality (FRAMO) index is based on 4 risk factors (age 80 years or older, weight less than 60 kg, previous fracture, and the need to use arms to rise) and reported a higher risk of hip fracture for women who had 2 or more of these 4 risk factors with an OR of 7.5 (95% CI, 3.0-18.4). 20 The FRAMO index is simple and easy to apply, but in contrast to the ERA index, it was developed using an exclusive sample of women. It also requires a functional evaluation that may be difficult to implement in all patients.…”

Can a risk factor questionnaire for osteoporosis and functional tests predict low bone mineral density or falls in patients with a distal radius fracture?

“…In the elderly and frailer patients, among whom functional tests are considered of value (38), it is possible that the one-leg rise test is enough. For example, the ability to rise from a chair is the only functional capacity that is included in the FRAMO-index (41). Even if the one-leg rise test did not associate to falls in this study, it may do so over a longer period.…”

Osteoporosis School in Primary Health Care-A Pilot Study

“…There was also a chair rising test five times without support of the arms. This test was assessed as being successful or not successful [16]. An experienced physiotherapist performed the clinical tests.…”