• Jian Sheng Chen, Philip N Sambrook, Judy M Simpson, Lyn M March, Robert G Cumming, Markus J Seibel, Stephen R Lord, and Ian D Cameron.
• Institute of Bone and Joint Research, Royal North Shore Hospital, New South Wales, Australia. jschen@med.usyd.edu.au
• J Clin Epidemiol. 2010 Jun 1; 63 (6): 679-85.

ObjectivesThe aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.Study Design And SettingTwo thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.ResultsOur fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.ConclusionThe index could help rationalize fracture prevention programs for frail older people.

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