QFracture

Risk of an osteoporotic or hip fracture. Open the calculator

Who is this information intended for?

This information is for clinicians and researchers who wish to use QFracture. The paper describing the original QFracture equations was published in the British Medical Journal, May 2012. This site implements the 2016 update.

What is osteoporosis and why is it important?

Osteoporosis is a term used by doctors to refer to changes in bone strength and density which can occur with advancing age and also caused by some medical conditions. The bones become less dense and more fragile and this can result in :

  • Hip fracture (also known as 'fractured neck of femur')
  • Distal radius fracture (which is a type of wrist fracture)
  • Vertebral fracture (which is a type of fracture of the spine)
  • Proximal humerus fracture (which is a fracture of the shoulder)
Osteoporosis is important as hip fractures almost always result in hospital admission and usually need an operation. Other fractures may not result in hospital admission but can cause pain and loss of function. It is important as it can be prevented.

What is QFracture?

QFracture is used to estimate an individual's risk of developing

  • hip fracture or
  • osteoporotic fracture (hip, spine, wrist or shoulder)
over the next 10 years.

The algorithms can be used to identify people at high risk of these fractures so they can be assessed in more detail to reduce their risk.

QFracture has been specifically developed by doctors and academics for use in the UK. The original research was done using the QResearch anonymised medical research database and published in the BMJ.

All medical decisions relating to both scores need to be taken by a patient in consultation with their doctor. The authors, Endeavour Predict CIC and University of Nottingham accept no responsibility for clinical use or misuse of the score.

Who can have a QFracture score calculated?

QFracture can be used to assess patients aged between 30 and 99 years unless they have already had an osteoporotic fracture.

How can I work out my risk of osteoporotic fracture?

The QFracture web calculator can be used to work out your risk of hip or osteoporotic fracture.

If you are a patient then you are welcome to use the web calculator to estimate your risk. If you are concerned about your estimated risk then please see a doctor or nurse for a full risk assessment.

Note though that this is just an estimate and that if you do not know some of the information needed for the calculator (like your body mass index) then it will substitute population average values for someone of your age and sex so the result is just a guide.

What factors are in the QFracture-2016 scores?

The following factors are needed to calculate a QFracture score in men and women:

  • Age
  • Sex
  • Ethnicity
  • Smoking status (non smoker, ex smoker, light, moderate, heavy)
  • Alcohol use
  • Type 1 or Type 2 diabetes
  • Parental history of hip fracture/osteoporosis
  • Nursing or care home residence
  • History of prior osteoporotic (wrist, spine, hip, or shoulder) fracture
  • History of falls
  • Dementia
  • Cancer
  • Asthma or COPD
  • Cardiovascular disease
  • Chronic liver disease
  • Chronic kidney disease
  • Parkinson's disease
  • Rheumatoid arthritis or systemic lupus erythematosis (SLE)
  • Gastrointestinal malabsorption (including Crohns disease, ulcerative colitis, celiac disease, steatorrhoea, blind loop syndrome)
  • Epilepsy or use of anticonvulsants
  • Use of antidepressants (at least 2 scripts in last 6 months)
  • Use of corticosteroids (at least 2 scripts in last 6 months)
  • Body mass index
Additional factors are used for women only:
  • Use of oestrogen only Hormone Replacement Therapy
  • Endocrine problems (thyrotoxicosis, primary or secondary hyperparathyroidism, Cushings syndrome)

What does '10 year risk' mean and why is it important?

10 year risk means the risk of someone developing an osteoporotic fracture over the next ten years. If someone has a 10 year score of 10% then in a crowd of 100 people like them, on average 10 people would get an osteoporotic fracture over the next 10 years. Or put another way, they have a 'one in ten' chance of getting a fracture over the next 10 years.

There is no generally agreed threshold, regarding the definition of high risk, equivalent to the 20% intervention threshold used for cardiovascular disease (which is a cost-effectiveness threshold set by NICE). Therefore, we have defined thresholds for QFracture based on the risks of patients within the QResearch database for men and women separately.

  • For women, the cut off for the top 10% at highest risk is a 10 year risk of 11.1%.
  • For men, the cut off for the top 10% at highest risk is 2.6%.
For further details see the paper in the BMJ.

What is body mass index and how is it measured?

Body mass index is a number calculated from height and weight. It is the weight in kilograms divided by the height in metres squared. Conventionally a person is considered to be obese if they have a body mass index over 30 kg/m2. If you do not enter a body mass index value on the web calculator it will assume an average value based on patients of the same age and sex as you.

What does 'parental history of hip fracture' mean?

You mother or father had a hip fracture probably due to osteoporosis.

How has QFracture been validated?

QFracture-2009 was developed using two thirds of general practices contributing to the QResearch database. Its performance was validated on one third of practices and also directly compared with the FRAX algorithm.

Additional validation of QFracture-2009 has been published by an external team using an independent dataset and the performance was found to be very good. The authors concluded that the QFracture Scores are useful tools for predicting the 10 year risk of osteoporotic and hip fractures in patients in the United Kingdom. The paper can be found here:

Independent validation of QFracture-2012 is currently in progress.

Why doesn't QFracture include bone mineral density?

QFracture does not include bone mineral density as it is seldom recorded in GP computer records and it is likely to only be measured in a selected high risk population Also bone mineral density is costly to measure. However QFracture could be used to select high risk patients for bone mineral density measurement as part of their assessment following identification of their high risk status for fracture.

What is the difference between QFracture and FRAX?

  • QFracture is similar to FRAX in that both scores can be used to calculate 10 year risk of hip fracture or osteoporotic fracture.
  • QFracture is suitable for use in patients aged 30-99 whereas FRAX is suitable for patients aged 30-90 years.
  • QFracture was developed and validated on an extremely large and representative primary care population. It has been specifically designed for use in primary care. FRAX was developed and validated on multiple clinical trial cohorts assembled for different studies at different times.
  • QFracture includes a more detailed assessment of smoking and alcohol intake than FRAX. This is because the evidence suggests that the effects of smoking and alcohol are dose dependent.
  • FRAX has been adapted for international use whereas the current version of QFracture is designed for use in the UK although it could be re-calibrated for international use in due course.
  • QFracture has additional factors which are not included in FRAX and therefore may provide a more individualised assessment of risk. These are:
    • Ethnicity
    • Smoking status (non smoker, ex smoker, light, moderate, heavy) has more categories
    • Alcohol use has more categories
    • Type 1 or Type 2 diabetes
    • Nursing or care home residence
    • History of falls
    • Dementia
    • Cancer
    • Asthma or COPD
    • Cardiovascular disease
    • Chronic liver disease
    • Chronic kidney disease
    • Parkinson's disease
    • Systemic lupus erythematosis (SLE)
    • Gastrointestinal malabsorption (including Crohns disease, ulcerative colitis, celiac disease, steatorrhoea, blind loop syndrome)
    • Epilepsy or use of anticonvulsants
    • Use of antidepressants (at least 2 scripts in last 6 months)
    Women only:
    • Use of oestrogen only Hormone Replacement Therapy
    • Endocrine problems (thyrotoxicosis, primary or secondary hyperparathyroidism, Cushings syndrome)

What things can I do myself to reduce my chances of getting osteoporosis?

You can do things yourself to lower your risk.

  • Take regular weight bearing exercise such as walking, jogging, running.
  • Stop smoking and reduce your alcohol intake
  • Make sure you have enough calcium and vitamin D in your diet
  • Reduce your risk of falling by
  • Removing loose rugs or small objects you might fall over at home
  • Make sure you can see properly (get an eye check done if you are worried about your sight)
  • Visit your GP for a check up if you feel dizzy when you stand or are unsteady on your feet.

What other interventions might help prevent osteoporotic fracture in high risk patients?

There is some evidence that daily supplementation with Vitamin D3 and calcium reduces hip fracture rates amongst high risk older patients in institutional care. Bisphosphonates seem to reduce hip and other fracture rates in community-dwelling older women less than 80 years of age. Hip protectors may reduce the incidence of hip fractures in institutional care provided that compliance/adherence is achieved. There is some evidence from this study and others that HRT reduces overall fracture risk. However, the risks and benefits of HRT for an individual patient need to be taken into consideration and HRT is currently not routinely recommended for prevention of osteoporosis.

Does HRT affect my chances of getting an osteoporotic fracture?

We examined many women prescribed HRT over the 15 year study period and found some evidence that some types of HRT reduce overall fracture risk. The effect is apparent within a year of starting HRT and increases over time. The protective effect appears to wear off once HRT is stopped. Some types of HRT appear to have a greater protective effect than others. For more details please see the paper in the BMJ.