A mental-functional risk score for prediction of hip fracture

We examined the apparent value of questions of functional status and mental score in determining the risk of hip fracture from a large retrospective case-control study undertaken in six countries. Of nine questions utilized in 75% of the MEDOS study population, four questions were found to be statistically significant and independently related to the risk of hip fracture. From this an additive score was devised with three points for not being able to wash or dress, six points for not knowing one's age, and ten points for not knowing the day of the week, which gave a gradient of risk of 5.7 when categorized into quartiles. Similar gradients of risk were observed in all countries. A less than perfect score was associated with a specificity of 79% and sensitivity of 46%, comparable to the power of bone mineral density measurements. The risk factor score accounted only partially for the increase in risk associated with dementia, cardiovascular accidents and parkinsonism. We conclude that the steep gradient of risk associated with this simple score should be evaluated prospectively.