Researchers from Uppsala University have developed a clinical model that can accurately predict the risk of hip fractures in the elderly. The model is based on analyzes of data from the entire Swedish population and can identify high-risk patients without the need to measure skeletal strength. This can speed up the process for doctors and ensure that patients can receive preventive treatment. This is evident from a new study published in the journal eClinical Medicine.
Approximately 15,000 hip fractures occur in Sweden every year. This causes pain to patients and makes them more dependent on family members, friends or healthcare staff. As many as 25 percent of those affected die within the first year, meaning the mortality rate is higher than for incidents such as stroke or heart attack. This means that if you can predict who will be affected, you can take preventive action and save lives.
The new study is based on registry data collected from the entire Swedish population. For five years, the researchers followed all people living in Sweden who were at least 50 years old to identify factors that increased the risk of hip fractures.
“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 a timely manner and offered preventive treatment,” explains Peter Nordström, professor and advisor. Doctor leading the research group.
Bone densitometry, currently the most commonly used method to assess fracture risk, has several limitations. It is a time-consuming examination that requires expensive equipment and is therefore not available to all doctors. The model that has now been developed is instead based on variables that are easier to collect in clinical settings, such as diagnoses and medical treatments. This allows healthcare staff to conduct risk assessments without access to bone densitometry equipment.
A major advantage of our model is that it is based on data already available in the clinic, which allows us to identify risk groups more quickly and easily. This allows us to start preventive interventions earlier, such as medication for osteoporosis, and prevent serious complications that occur with hip fractures.”
Peter Nordström, professor and consulting physician
Based on 19 variables
The research model is based on 19 variables, with the strongest predictors – apart from advanced age – being the use of home care services and diagnoses such as Parkinson’s disease and dementia. The model showed that women with home health services had a risk of almost 8% of hip fracture over a five-year period, while the corresponding figure for men was 5%.
“A key insight from our research is that frailty, which home health services can reflect, is a strong indicator of hip fracture. It helps us see that it’s not just about bone density, but the entire health situation of each individual,” notes. Anna Nordström, one of the researchers behind the study.
Treatment can be started earlier
A key key finding of the study was that the researchers were able to establish a risk threshold for when treatment with bone-strengthening drugs should be considered. If someone has a 3 percent or greater risk of hip fracture within five years, preventative medication may be helpful. According to the model, 36 women or 52 men would therefore need treatment to prevent a hip fracture.
“This model could have a major impact on the elderly, especially those whose bone density has not been measured. It gives us a tool to identify risk groups early and take preventive measures before a hip fracture occurs,” says Nordström.
The research has also been validated among people with a foreign background and proved to be equally accurate. The results were recently published and the research may lead to new guidelines on how healthcare providers should manage the risk of hip fractures in the elderly.
Link to the hip fracture risk calculation algorithm, which is free to use:
https://www.healthy-ageing.life/shafre-fracture-risk-assessment
The 19 factors on which the algorithm is based are: age, gender, osteoporosis, Parkinson’s disease, alcohol abuse, dementia, hip fracture in siblings, previous fractures, rheumatoid arthritis, chronic pulmonary obstruction, kidney disease, stroke, depression or antidepressants, psychosis or neuroleptics, Swedish background, low income, nursing home resident, home care services and oral corticosteroids.
Source:
Magazine reference:
Nordström, P., et al. (2024) A new clinical prediction model for hip fractures: a development and validation study in the total population of Sweden. eClinical Medicine. doi.org/10.1016/j.eclinm.2024.102877.