Objective: Elderly patients presenting with falls are known to carry an extremely high risk of future fragility fractures. Current osteoporosis guidelines recommend using fracture risk calculators such as FRAX, QFracture or Garvan to guide management. However, they differ considerably in their inputs and may therefore provide contrasting risk estimations in certain individuals. In this study, we compared these risk calculators in a high-risk cohort of elderly patients admitted to hospital with falls.

Design: Hospital-based cross-sectional study.

Setting: Secondary care, London, United Kingdom

Participants: Data from 120 consecutive elderly falls patients presenting to a single hospital over 4 months were collected. 10-year major and hip fracture risks were calculated using FRAX, QFracture and Garvan. 1-year major and hip fracture risks from QFracture were assessed against prospective incidence of fracture.

Results: Median 10-year major fracture risk was: FRAX 19.5%, QFracture 26.0%, Garvan 32.5%. Median 10-year hip fracture risk was: FRAX 9.6%, QFracture 21.2%, Garvan 6.5%. Correlation between FRAX-QFracture was r=0.672 for major, r=0.676 for hip fracture (both p<0.0001); FRAX-Garvan r=0.778 (p<0.0001) for major, r=0.128 (p=0.206) for hip fracture; QFracture-Garvan r=0.658 (p<0.0001) for major, r=0.318 (p<0.001) for hip fracture. QFracture 1-year predicted major and hip fracture rates were 1.8% and 1.2% respectively, compared to actual rates of 2.1% and 0%
respectively.

Conclusions: Although strong correlations between calculators were observed in the study cohort, there were differences of up to 13% between risks. QFracture captured several elderly-specific inputs not considered by other calculators and so projected higher fracture risk than the other calculators. QFracture provided 1-year fracture risks that were comparable with the prospective observed fracture incidence in the cohort. This study has important clinical implications for the use of fracture risk calculators to guide treatment decisions, particularly in the high-risk cohort of elderly patients admitted with falls to hospital.