Robbins J et al. (2007) Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 298: 2389–2398

Identifying the factors that might lead to bone fractures can help physicians to suggest preventive lifestyle changes for at-risk patients. To create a predictive algorithm, Robbins et al. evaluated the clinical risk factors for hip fracture within 5 years in postmenopausal women.

In an observational, multiethnic cohort of the Women's Health Initiative (WHI) consisting of 93,676 women, risk of hip fracture was assessed by questionnaires over a mean of 7.6 years. A prediction model based on findings from the observational cohort was created, and validated in 68,132 women enrolled in the clinical trial of the WHI, with a mean follow-up of 8.0 years. The authors developed a simplified point score to identify the probability of hip fracture.

Eleven factors selected from the observational study predicted hip fracture within 5 years: age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after the age of 55 years, parental hip fracture, current smoking, current corticosteroid use and diabetes treated with medications. During the observational study 1,132 hip fractures occurred, and 791 hip fractures were reported during the clinical trial. In the clinical trial group, most hip fractures occurred in women predicted to be at low risk by the algorithm.

Age alone is the best predictor of hip fracture; however, this study demonstrated that prediction can be enhanced with the addition of other factors.