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Updated: Oct 7, 2025
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Evaluating the performance of the Charlson Comorbidity Index (CCI) in fracture risk prediction and developing a new
A Clausen1, S Möller1,2, M K Skjødt2,3
1OPEN - Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
Insights
The Charlson Comorbidity Index (CCI) has poor accuracy for predicting osteoporotic fractures. A modified Charlson Fracture Index (CFI) shows fair accuracy for predicting hip fracture risk in both men and women.
Area of Science:
- Gerontology and Geriatric Medicine
- Epidemiology
- Orthopedics
Background:
- The Charlson Comorbidity Index (CCI) is a widely used tool for assessing disease burden.
- Several diagnoses within the CCI are known predictors of fracture risk.
- Existing CCI versions (1987 and 2011) have not been specifically evaluated for fracture risk prediction.
Purpose of the Study:
- To evaluate the performance of the CCI 1987 and CCI 2011 in predicting major osteoporotic fracture (MOF) and hip fracture (HF).
- To assess if modifying the CCI can improve its accuracy in predicting fracture risk.
- To introduce and validate a new Charlson Fracture Index (CFI).
Main Methods:
- Utilized the entire Danish population aged 45+ as of January 1, 2018, split into development and validation cohorts.
- Identified CCI diagnoses and fracture outcomes from hospital records.
- Developed a new Charlson Fracture Index (CFI) by updating diagnosis weightings using multivariable logistic regression and evaluated predictive capabilities using ROC curves and AUC.
Main Results:
- The CCI 1987 and CCI 2011 demonstrated AUCs below 0.7 for predicting MOF and HF in both sexes.
- The CFI showed AUCs below 0.7 for MOF prediction in both sexes.
- The CFI achieved fair accuracy in predicting hip fractures, with AUCs of 0.755 in women and 0.782 in men.
Conclusions:
- The original CCI 1987 and CCI 2011 versions exhibit poor accuracy for predicting osteoporotic fractures.
- The newly developed Charlson Fracture Index (CFI) demonstrates fair accuracy in predicting hip fractures.
- The CFI shows potential utility in identifying individuals at high risk for hip fractures.
Abstract:
The Charlson Comorbidity Index (CCI) may be applicable for predicting fracture risk since several diagnoses from the index are predictors of fracture. Main results were that the CCI was updated to predict risk of hip fracture with fair precision and that the index could be useful in detecting high-risk individuals.
Purpose:
Several of the Charlson Comorbidity Index (CCI) diagnoses are validated predictors of fracture. The purpose of this study was to evaluate the performance of the CCI 1987 by Charlson et al. and of the CCI 2011 by Quan et al. in predicting major osteoporotic fracture (MOF) and hip fracture (HF). Furthermore, it was examined whether the index could be modified to improve fracture risk prediction.
Methods:
The study population included the entire Danish population aged 45 + years as per January 1, 2018. The cohort was split randomly 50/50 into a development and a validation cohort. CCI diagnoses and fracture outcomes were identified from hospital diagnoses. The weighting of diagnoses was updated in a new Charlson Fracture Index (CFI) using multivariable logistic regression. Predictive capabilities of the CCI 1987, the updated CCI 2011 and the new Charlson Fracture index were evaluated in the validation cohort by receiver operating characteristics (ROC) curves and area under the curve (AUC).
Results:
In the validation cohort, the 1987 and 2011 CCIs resulted in AUCs below or around 0.7 in prediction of MOF and HF in both sexes. The CFI resulted in AUCs < 0.7 in prediction of MOF in both sexes. In prediction of HF, the CFI resulted in AUC of 0.755 (95% CI 0.749; 0.761) in women and 0.782 (95% CI 0.772; 0.793) in men.
Conclusion:
The 1987 and 2011 CCIs showed overall poor accuracy in fracture risk prediction. The CFI showed fair accuracy in prediction of HF in women and in men.
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