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29-03-2010 | Bone health | Article

Combined approach identifies women with greatest hip fracture risk


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MedWire News: A combination of high Fracture and Mortality (FRAMO) Index, prior fragility fracture, and very low heel bone mineral density (BMD) identifies women at greatest risk for hip fracture, a Swedish population-based study has shown.

In their study, Daniel Albertsson (Göteborg University) and colleagues revalidated the four-item FRAMO clinical risk score and evaluated whether it can predict hip fracture or fragility fracture (FF) alone or in combination with BMD at the heel.

The researchers assessed 285 elderly women involved in a fracture-prevention program using the FRAMO index, which combines an age of 80 years or older, weight below 60 kg, prior fragility fracture, and impaired rise-up ability as clinical risk factors.

During 2 years of follow-up, seven (2.5%) women suffered hip fractures and 14 (5%) women suffered FF at the hip, radius, humerus, or pelvis.

There were 88 (31%) women with two or more FRAMO risk factors who were consequently classified as high risk. These women had a 5.9-fold increased risk for hip fracture and a 4.4-fold increased risk for FF, compared with women who had less than two risk factors. The annual fracture risk for women in the high-risk group was 2.8% compared with 0.5% for the low-risk majority.

Portable dual X-ray laser absorptiometry analysis revealed that each standard deviation (SD) decrease in heel BMD was associated with a 3.1-fold increased likelihood for hip fracture and a 2.6-fold increased likelihood for FF. In addition, mean hip BMD corresponded to BMD at the heel among 30 participants assessed by dual X-ray absorptiometry.

By combining high FRAMO Index, prior fragility fracture, and T-score of -3.5 SD or lower, Albertsson and team identified a small very high-risk group of 32 (11%) women who suffered five (71%) of the seven hip fractures observed. These women had an annual absolute risk for hip fracture of 7.8% and 23-fold increased likelihood for fracture compared with women not in this group.

“If these results are confirmed in larger studies this [combined] screening procedure could concentrate hip fracture prevention to persons at very high risk,” conclude Albertsson and co-authors in the journal BMC Musculoskeletal Disorders.

This could reduce the cost and side effects of unnecessary prevention strategies, they add.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Laura Dean

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