Clinical Model Accurately Predicts Risk of Hip Fractures in Elderly

Each year, thousands of hip fractures occur, causing significant pain for patients and increasing their dependence on family, friends, or healthcare staff. Approximately 25% of those impacted die within the first year, resulting in a mortality rate that surpasses that of events such as strokes or heart attacks. This indicates that if clinicians can predict who is likely to be affected, they can implement preventive measures and potentially save lives. Currently, bone densitometry is the most widely utilized method for assessing fracture risk; however, it has several drawbacks. The examination is time-consuming, requires costly equipment, and is not readily accessible to all physicians. Researchers have now created a clinical model that can accurately predict the risk of hip fractures in older adults. This model can identify high-risk patients without the need for measuring skeletal strength, which can speed up the process for doctors and enable timely preventive treatment.

The new study conducted by researchers at Uppsala University (Uppsala, Sweden) is based on registry data gathered from the entire Swedish population. For five years, the researchers tracked all individuals living in Sweden aged 50 and older to identify factors that elevate the risk of hip fractures. The newly developed model relies on variables that are easier to collect in clinical environments, such as diagnoses and medical treatments. This enables healthcare personnel to perform risk assessments without needing access to bone densitometry equipment. The research model is founded on 19 variables, with the strongest predictors—apart from advanced age—being the use of home-help services and diagnoses such as Parkinson's disease and dementia. The model indicated that women utilizing home-help services face a nearly 8% risk of suffering a hip fracture within five years, while the corresponding risk for men is 5%.

A significant finding of the study was the establishment of a risk threshold for when treatment with bone-strengthening medications should be considered. If an individual has a 3% or higher risk of experiencing a hip fracture within five years, preventive medication could be advantageous. According to the model, 36 women or 52 men would therefore require treatment to avert a hip fracture. This study has also been validated among individuals from foreign backgrounds, demonstrating equal accuracy in that group. The research findings published in the journal eClinicalMedicine could inform new guidelines on how healthcare providers should approach the management of hip fracture risk in older adults.

“The most surprising result was that we could predict hip fractures so accurately without using bone density, which has traditionally been an important factor. This means that more people can be identified in time and offered preventive treatment,” said Peter Nordström, Professor and Consultant Physician who led the research group. “A major advantage of our model is that it is based on data already available in the clinic, which allows us to identify at-risk groups more quickly and easily. This in turn enables us to start preventive interventions earlier, such as medication for osteoporosis, and prevent serious complications that occur in hip fractures.”

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