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Experts say easy-to-use risk tool will help in applying NICE guidelines

Just four questions can predict hip fracture risk

GPs can use a combination of just four risk factors to accurately predict a woman's risk of a hip fracture, a study reports.

The four-item screening tool was developed for primary care and is practical and quick to use, the researchers said.

The tool assigns an absolute risk of fracture to individual women – which GP experts said would allow NICE guidelines to be applied more easily (see graphic below).

Women assessed by the tool as having either none or one of the factors had a two-year risk of 0.8 per cent for hip fracture and 3.2 per cent for mortality.

By contrast, the risk among women with two to four factors was far higher, at 5.4 per cent for hip fracture and 23.7 per cent for mortality.

The tool, called the FRAMO index, was validated in a group of 1,248 Swedish patients with details published in the January/February issue of Annals of Family Medicine.

Study leader Dr Daniel Albertsson, a clinical researcher in the department of primary health care at Gothenburg University, Sweden, said the index would be 'practical for routine use in primary care'.

'It identified the majority of women who experienced hip fractures during a two-year follow-up, and who might have been candidates for intensified preventive measures.'

Professor Jonathan Bayly, associate lecturer in osteoporosis at the University of Derby and a former GP, said: 'It synthesises four well-known skeletal and non-skeletal risk factors in one case-finding tool that's easily usable in primary care.'

Professor Bayly said its use might help to improve adherence to NICE guidance, which was currently 'microscopic'.

But he warned that although the use of risk predictors like this could 'move us on at least', it was harder to find effective interventions.

Dr Peter Stott, a member of the scientific advisory committee of the National Osteoporosis Society and a GP in Tadworth, Surrey, said the tool could help to cut through the complexity of current guidance.

He said: 'The guidance so far has been difficult to work, because there's so much detail. These are nice simple guidelines that give GPs an idea on who to treat.'

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