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). 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 fracture. The latter is defined by the WHO as a hip, clinical vertebral, distal forearm, or humerus fracture. Ensrud et al, 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-