Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study
Objective Elderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060282.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832577714838568960 |
|---|---|
| author | Sophia von Widekind Georgi Todorov Susan Brook Nicole Quah Qin Xian Bernard Freudenthal Alexander N Comninos |
| author_facet | Sophia von Widekind Georgi Todorov Susan Brook Nicole Quah Qin Xian Bernard Freudenthal Alexander N Comninos |
| author_sort | Sophia von Widekind |
| collection | DOAJ |
| description | Objective Elderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs and may therefore provide contrasting risk estimations in certain individuals. In this study, we compare these risk calculators in a high-risk cohort of elderly patients admitted to hospital with falls.Design Hospital-based cross-sectional study.Setting Secondary care, London, UK.Participants Data from 120 consecutive elderly patients who had falls presenting to a single hospital over 4 months were collected. 10-year major and hip fracture risks were calculated using FRAX, QFracture and Garvan. 1-year major and hip fracture risks from QFracture were assessed against prospective incidence of fracture.Results Median 10-year major fracture risk was: FRAX 19.5%, QFracture 26.0%, Garvan 32.5%. Median 10-year hip fracture risk was: FRAX 9.6%, QFracture 21.1%, Garvan 6.5%. Correlation between FRAX and QFracture was r=0.672 for major, r=0.676 for hip fracture (both p<0.0001); FRAX and Garvan r=0.778 (p<0.0001) for major, r=0.128 (p=0.206) for hip fracture; QFracture and Garvan r=0.658 (p<0.0001) for major, r=0.318 (p<0.001) for hip fracture. QFracture 1-year predicted major and hip fracture rates were 1.8% and 1.2%, respectively, compared with actual rates of 2.1% and 0%, respectively.Conclusions Although strong correlations between calculators were observed in the study cohort, there were differences of up to 13% between estimated risks. QFracture captured several elderly-specific inputs not considered by other calculators and so projected higher fracture risk than the other calculators. QFracture provided 1-year fracture risks that were comparable with the prospective observed fracture incidence in the cohort. This study has important clinical implications for the use of fracture risk calculators to guide treatment decisions, particularly in the high-risk cohort of elderly patients admitted to hospital following falls. |
| format | Article |
| id | doaj-art-01b02a9b7bdb4d7982dc5a75ad4239af |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-01b02a9b7bdb4d7982dc5a75ad4239af2025-01-30T15:55:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060282Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional studySophia von Widekind0Georgi Todorov1Susan Brook2Nicole Quah Qin Xian3Bernard Freudenthal4Alexander N Comninos5Department of Acute Medicine, Imperial College Healthcare NHS Trust, London, UKDepartment of Medicine for the Elderly, West Middlesex University Hospital, Isleworth, UKDepartment of Medicine for the Elderly, Imperial College Healthcare NHS Trust, London, UKDepartment of Acute Medicine, Imperial College Healthcare NHS Trust, London, UKEndocrine Bone Unit, Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UKEndocrine Bone Unit, Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UKObjective Elderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs and may therefore provide contrasting risk estimations in certain individuals. In this study, we compare these risk calculators in a high-risk cohort of elderly patients admitted to hospital with falls.Design Hospital-based cross-sectional study.Setting Secondary care, London, UK.Participants Data from 120 consecutive elderly patients who had falls presenting to a single hospital over 4 months were collected. 10-year major and hip fracture risks were calculated using FRAX, QFracture and Garvan. 1-year major and hip fracture risks from QFracture were assessed against prospective incidence of fracture.Results Median 10-year major fracture risk was: FRAX 19.5%, QFracture 26.0%, Garvan 32.5%. Median 10-year hip fracture risk was: FRAX 9.6%, QFracture 21.1%, Garvan 6.5%. Correlation between FRAX and QFracture was r=0.672 for major, r=0.676 for hip fracture (both p<0.0001); FRAX and Garvan r=0.778 (p<0.0001) for major, r=0.128 (p=0.206) for hip fracture; QFracture and Garvan r=0.658 (p<0.0001) for major, r=0.318 (p<0.001) for hip fracture. QFracture 1-year predicted major and hip fracture rates were 1.8% and 1.2%, respectively, compared with actual rates of 2.1% and 0%, respectively.Conclusions Although strong correlations between calculators were observed in the study cohort, there were differences of up to 13% between estimated risks. QFracture captured several elderly-specific inputs not considered by other calculators and so projected higher fracture risk than the other calculators. QFracture provided 1-year fracture risks that were comparable with the prospective observed fracture incidence in the cohort. This study has important clinical implications for the use of fracture risk calculators to guide treatment decisions, particularly in the high-risk cohort of elderly patients admitted to hospital following falls.https://bmjopen.bmj.com/content/12/7/e060282.full |
| spellingShingle | Sophia von Widekind Georgi Todorov Susan Brook Nicole Quah Qin Xian Bernard Freudenthal Alexander N Comninos Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study BMJ Open |
| title | Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study |
| title_full | Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study |
| title_fullStr | Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study |
| title_full_unstemmed | Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study |
| title_short | Comparison of fracture risk calculators in elderly fallers: a hospital-based cross-sectional study |
| title_sort | comparison of fracture risk calculators in elderly fallers a hospital based cross sectional study |
| url | https://bmjopen.bmj.com/content/12/7/e060282.full |
| work_keys_str_mv | AT sophiavonwidekind comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy AT georgitodorov comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy AT susanbrook comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy AT nicolequahqinxian comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy AT bernardfreudenthal comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy AT alexanderncomninos comparisonoffractureriskcalculatorsinelderlyfallersahospitalbasedcrosssectionalstudy |