Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model.
B Catharine Craven, Lora M Giangregorio, Isabelle Côté and 3 others
PMID 38174130WHAT IT FOUND
A preliminary risk score using five clinical factors estimates 5-year lower extremity fracture risk in chronic spinal cord injury.
Prior fracture and duration of injury drive the score. The model is not validated for clinical use due to small sample size.
Key findings
01The model estimates 5-year fracture risk based on prior fracture, years post-injury, motor completeness, parental osteoporosis, and opioid use.
02In the example provided, a patient with motor complete SCI for 10 years, on opioids, with parental hip fracture history, had an estimated 20% 5-year fracture risk.
03The authors state the model is preliminary and not ready for clinical implementation because the small sample size could result in overestimation of risk.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The sample size was very small (90 participants) with only 13 fracture cases, making the statistical model unstable and prone to overfitting. The model was developed and tested on the same data, so its accuracy in new patients is unknown. The exact timing of fractures was not always known, preventing more precise survival analysis. The authors explicitly state the model is not ready for clinical implementation.
Declared interests
Funding came from CIHR, Ontario Ministry of Health, Paralyzed Veterans of America, Craig H. Nielsen Foundation, and Praxis Spinal Cord Institute. No commercial conflicts of interest were reported.
The easy way to misread this
Do not use this risk score to deny rehabilitation activities or prescribe medication. The model is preliminary, unvalidated, and the authors warn it may overestimate fracture risk due to the small sample size.