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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 > or = 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.

Original publication




Journal article



Publication Date





673 - 682


Accidental Falls, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Female, Fractures, Bone, Hip Fractures, Humans, Incidence, Menopause, Middle Aged, Risk Assessment, Risk Factors, Smoking, United Kingdom