Validated risk rule using computerized data to identify males at high risk for fracture.

Area of Science:

• Geriatric Medicine
• Public Health
• Epidemiology

Background:

• Absolute risk assessment is preferred for osteoporosis treatment decisions.
• Current risk rules perform poorly in men, leading to undertreatment.
• Osteoporosis is often overlooked and undertreated in male populations.

Purpose of the Study:

• To determine if passively collected data can identify high-risk male veterans for fractures.
• To develop and validate risk stratification rules for hip and major fractures in male veterans.
• To assess the discrimination of these rules for fracture prediction.

Main Methods:

• Utilized administrative and clinical databases for male veterans aged 50+ (2005-2006).
• Developed prognostic models using Cox regression for hip and major fractures.
• Validated risk stratification rules and created risk scores for fracture prediction.

Main Results:

• Predictive models showed good discrimination (C-statistics: 0.81 for hip, 0.74 for any major fracture).
• The rule identified all hip fractures in patients with prior fractures and 67% in those without.
• For any major fracture, the rule identified all fractures in patients with prior fractures and 56% in those without.

Conclusions:

• Passively collected data can effectively identify male veterans at high risk for fracture.
• The developed risk stratification rules offer better discrimination than other methods in men.
• These findings support the development of clinical decision support tools for fracture prevention.