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Published on: August 17, 2017
A mental-functional risk score for prediction of hip fracture
J Ranstam1, L Elffors, J A Kanis
1Department of Community Health Sciences, Lund University, Malmö General Hospital, Sweden.
Insights
Simple questions about daily function and mental status can predict hip fracture risk. A score combining inability to dress, recall age, and day of week shows significant risk gradients.
Area of Science:
- Gerontology
- Epidemiology
- Orthopedics
Background:
- Hip fractures pose a significant health risk, particularly in aging populations.
- Identifying individuals at high risk is crucial for preventive strategies.
- Existing risk assessment tools may not fully capture functional and cognitive decline.
Purpose of the Study:
- To evaluate the utility of functional status and mental score questions in predicting hip fracture risk.
- To develop and validate a simple risk score for hip fractures.
- To compare the predictive power of this score with bone mineral density measurements.
Main Methods:
- Retrospective case-control study involving a large population across six countries (MEDOS study).
- Analysis of nine questions related to functional status and mental assessment.
- Development of an additive risk score based on statistically significant questions.
Main Results:
- Four specific questions independently predicted hip fracture risk.
- An additive score (inability to dress, recall age, day of week) showed a risk gradient of 5.7 across quartiles.
- The score demonstrated comparable sensitivity (46%) and specificity (79%) to bone mineral density measurements.
- The score partially explained increased risk associated with dementia, cardiovascular accidents, and parkinsonism.
Conclusions:
- A simple, easily administered risk score effectively identifies individuals at high risk for hip fracture.
- This score offers a valuable, accessible tool for risk stratification in diverse populations.
- Prospective evaluation of this risk score is warranted to confirm its clinical utility.
Abstract:
We examined the apparent value of questions of functional status and mental score in determining the risk of hip fracture from a large retrospective case--control study undertaken in six countries. Of nine questions utilized in 75% of the MEDOS study population, four questions were found to be statistically significant and independently related to the risk of hip fracture. From this an additive score was devised with three points for not being able to wash or dress, six points for not knowing one's age, and ten points for not knowing the day of the week, which gave a gradient of risk of 5.7 when categorized into quartiles. Similar gradients of risk were observed in all countries. A less than perfect score was associated with a specificity of 79% and sensitivity of 46%, comparable to the power of bone mineral density measurements. The risk factor score accounted only partially for the increase in risk associated with dementia, cardiovascular accidents and parkinsonism. We conclude that the steep gradient of risk associated with this simple score should be evaluated prospectively.
