Abstract
Introduction
Current NICE guideline recommends the use of either the FRAX or Qfracture score to assess the probability of future fragility fractures before measuring a patient’s bone mineral density. However, Qfracture has poor predictive ability in patients above the age of 85. As such, we investigated if the addition of clinical frailty status may enhance Qfracture risk prediction in an older age group.
Methods
Data were collected from consecutive admissions to an Emergency Frailty Unit (EFU) ofoin Ysbyty Ystrad Fawr Hospital, between 1 April 2015 to 31 March 2017. Demographic information, Clinical Frailty Score (CFS), Charlson Co-morbidity Index (CCI), and Barthel Index (BI) were obtained on patient admission. Qfracture scores were calculated and the database was reviewed for any fragility fractures sustained. Receiver operating characteristics (ROC) curves were generated for all possible variables that may predict fragility fractures in patients. Area under the curve (AUC) results were also calculated, with standard error, significance, and 95% confidence intervals.
Results
A total of 1503 admissions were recorded. After filtering for missing data and repeated admissions for the same patients, 790 patients (Male n=304, Female n=486) were included in the final analysis. A total of 148 fragility fractures were recorded. Average CFS (Male 6.4±1.2, Female 6.5±1.1) and CCI (Male 6.5±2.3, Female 6.2±2.0) is as noted. Average Qfracture score (10 year risk for all fractures) were recorded to be 14.9±10.3 for male participants and 25.7±11.3 for female participants respectively. ROC curves and AUC analyses generated shows that CFS (AUC 0.466 p=0.200), CCI (AUC 0.500, p=0.986) and BI (AUC 0.511, p=0.671) have no predictive ability for fragility fractures.
Conclusion
This study did not demonstrate enhanced predictive ability in the Qfracture score, with the additional of clinical frailty status. (283 words)