Abstract
Objective
To determine whether an Elders Risk Assessment (ERA) index can predict incident hip
fractures without the need for physician-patient encounter or bone mineral density
testing.
Patients and Methods
A retrospective cohort study was conducted in a community-based cohort of 12,650 patients
aged 60 years and older. An ERA score was computed for each subject at index time
(January 1, 2005). Incidents of hip fracture from January 1, 2005, through December
31, 2006, were obtained from electronic medical records. We divided the cohort into
5 groups, with the lowest ERA scores forming group A (<15%); 15% to 49%, group B;
50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as
a reference group, we used logistic regression to compute odds ratios of sustaining
hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for
groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were
calculated, and a receiver operating characteristic curve was created.
Results
Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January
1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups
B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9),
respectively. The area under the receiver operating characteristic curve was 74.5%.
Conclusion
An electronic medical record–based, easily derived ERA index might be useful in hip
fracture risk stratification.
Abbreviations and Acronyms:
CI (confidence interval), EMR (electronic medical record), ERA (Elders Risk Assessment), FNBMD (femoral neck bone mineral density), FRAMO (Fracture and Mortality), FRAX (fracture risk assessment), GDMS (Generic Disease Management System), ICD-9 (International Classification of Diseases, Ninth Revision), OR (odds ratio), PCIM (Primary Care Internal Medicine), ROC (receiver operating characteristic)To read this article in full you will need to make a payment
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Article Info
Footnotes
Grant Support: This research was funded by the Mayo Clinic Department of Medicine Write-up and Publish grant, the Mayo School of Graduate Medical Education Geriatrics Medicine Fellowship Program, and the Mayo Graduate School Clinical and Transitional Science program. The Mayo Graduate School Clinical and Transitional Science program is funded by the Mayo Clinic Center and Transitional Science Activities grant ( U54 RR 024150 ).
Identification
Copyright
© 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
