Predicting Hip and Major Osteoporotic Fractures Using Administrative Data

T he Fracture Risk Assessment tool (FRAX) was released in 2008 by the World Health Organization (WHO). 1 The FRAX algorithm uses bone mineral density (BMD) and 11 additional clinical and physiological risk factors to estimate a person's 10-year probability of hip and other major osteoporotic frac-ture. 2The latter is defined by the WHO as a hip, clinical vertebral, distal forearm, or humerus fracture.Ensrud et al, 3 using risk prediction models that included only age and BMD or age and fracture history, concluded that these few risk factors predicted 10-year risk of hip and other major osteoporotic fractures as well as FRAX-based models.We performed a similar evaluation using administrative claims data, which do not include information on BMD.We derived and examined several fracture risk prediction models to determine if demographics, history of fracture, and comorbidities-all identifiable within administrative claims data-could be used to predict hip fracture and major osteoporotic fractures, as well as models with additional clinical information or models de-Table.Weighted C Statistics in Predicting Hip and Major Osteoporotic Fractures a Variable Model 1 b (Demographic, Fracture History, Comorbidity) Model 2 c (Demographic