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Original Contribution
November 28, 2007

Factors Associated With 5-Year Risk of Hip Fracture in Postmenopausal Women

Author Affiliations

Author Affiliations: Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento (Dr Robbins); Fred Hutchinson Cancer Research Center, Seattle, Washington (Mr Aragaki and Dr Kooperberg); University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Watts); Division of Endocrinology, Diabetes and Metabolism, University at Buffalo, Buffalo, New York (Dr Wactawski-Wende); Department of Internal Medicine and Physical Medicine, Ohio State University, Columbus (Dr Jackson); Department of Medicine, Harvard Medical School, Boston, Massachusetts (Dr LeBoff); Division of Preventive Medicine, University of Alabama at Birmingham, (Dr Lewis); Division of Epidemiology and Biostatistics, University of Arizona, Tucson (Dr Chen); Stanford Prevention Research Center, Stanford, California (Dr Stefanick); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Cauley).

JAMA. 2007;298(20):2389-2398. doi:10.1001/jama.298.20.2389

Context The 329 000 hip fractures that annually occur in the United States are associated with high morbidity, mortality, and cost. Identification of those at high risk is a step toward prevention.

Objective To develop an algorithm to predict the 5-year risk of hip fracture in postmenopausal women.

Design, Setting, and Participants A total of 93 676 women who participated in the observational component of the Women's Health Initiative (WHI), a multiethnic longitudinal study, were used to develop a predictive algorithm based on commonly available clinical features. Selected factors that predicted hip fracture were then validated by 68 132 women who participated in the clinical trial. The model was tested in a subset of 10 750 women who had undergone dual-energy x-ray absorptiometry (DXA) scans for bone mass density assessment.

Main Outcome Measure The prediction of centrally adjudicated hip fracture, measured by the area under the receiver operator characteristic (ROC) curves.

Results During a mean (SD) follow-up of 7.6 (1.7) years, 1132 hip fractures were identified among women participating in the observational study (annualized rate, 0.16%), whereas during a mean follow-up of 8.0 (1.7) years, 791 hip fractures occurred among women participating in the clinical trial (annualized rate, 0.14%). Eleven factors predicted hip fracture within 5 years: age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes. Receiver operating characteristic curves showed that the algorithm had an area under the curve of 80% (95% confidence interval [CI], 0.77%-0.82%) when tested in the cohort of different women who were in the clinical trial. A simplified point score was developed for the probability of hip fracture. Receiver operating characteristic curves comparing DXA-scan prediction based on a 10% subset of the cohort and the algorithm among those who participated the clinical trial were similar, with an area under the curve of 79% (95% CI, 73%-85%) vs 71% (95% CI, 66%-76%).

Conclusion This algorithm, based on 11 clinical factors, may be useful to predict the 5-year risk of hip fracture among postmenopausal women of various ethnic backgrounds. Further studies are needed to assess the clinical implication of the algorithm in general and specifically to identify treatment benefits.