Researchers recently evaluated three tools to help predict risk of hip fracture in adults aged 80 and older, a population that accounts for 70% of hip fractures in the United States. The three processes included the Fracture Risk Assessment Tool (FRAX), the Garvan Fracture Risk Calculator and femoral neck bone mineral density (FNBMD). Study results confirmed that the simpler process, FNBMD, performed best. FRAX slightly underestimated hip fracture probability in intermediate-risk individuals, while Garvan significantly overestimated hip fracture probability in high-risk individuals.
This finding followed an analysis of nearly 9,000 study participants and a comparison of performance data from the more complex fracture risk calculators, FRAX and Garvan, with the simpler FNBMD process.
Participants were contacted every four or six months after index examination to collect vital status and any hip fracture updates. Predicted 5-year hip fracture calculations were based on using FRAX and Garvan models along with FNBMD and FNBMD alone.
The study found that FNBMD on its own performed at least as well in predicting five-year hip fracture risk as the more complex tools. The researchers noted that a lower femoral neck bone mineral density was independently associated with increased hip fracture risk in both women and men, even after accounting for competing mortality risk.
Interestingly, the study suggested that increasing age is not as strongly associated with hip fracture risk in adults over 80 compared to younger older populations, especially among women. This finding likely reflects the higher competing mortality risk before hip fracture in late life.
Until better prediction tools are available, the researchers concluded, clinicians should prioritize consideration of hip bone mineral density, life expectancy and patient preferences in decision-making regarding drug treatment initiation for hip fracture prevention in late-life adults.
