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    A combined fracture and mortality risk index useful fortreatment stratification in hip fragility fractures
    (Bayçınar Tıbbi Yayıncılık, 2021) Sezgin, Erdem Aras; Tor, Ahmet Toygun; Markeviciute, Vetra; Sirka, Aurimas; Tarasevičius, Šarūnas; Raina, Deepak Bushan; Liu, Yang; Isaksson, Hanna; Tägil, Magnus; Lidgren, Lars
    In this study, we aimed to assess the stratification abilityof the Fracture and Mortality Risk Evaluation (FAME) index forreoperation, new fragility fracture, and mortality during one-yearfollow-up. Patients and methods: Between November 2018 and July 2019,a total of 94 consecutive hip fragility fracture patients fromtwo centers (20 males, 74 females; mean age: 79.3±8.9 years;range, 57 to 100 years) were retrospectively analyzed. The patientswere classified into high, intermediate, and low fracture andmortality risk groups according to the Fracture Risk AssessmentTool (FRAX) score and Sernbo score, respectively, as well asnine combined categories according to the FAME index. Hospitalrecords were reviewed to identify re-fractures (reoperations,implant failure, new fragility fractures on any site) and mortality atone year following the FAME index classification. Results: Overall re-fracture and mortality rates were 20.2% and33%, respectively. High fracture risk category (FRAX-H) wassignificantly associated with higher re-fracture (odds ratio [OR]:2.9, 95% confidence interval [CI]: 1-8.2, p=0.037) and mortalityrates compared to others (OR: 3.7, 95% CI: 1.5-9.3, p=0.003).The patients classified within the FRAX-H category (n=35) haddifferent mortality rates according to their Sernbo classification;i.e., patients classified as low mortality risk (Sernbo-L) (n=17) hadlower mortality rates compared to others in this group (n=18) (35.3%and 66.7%, respectively), indicating a low statistical significance(OR: 0.3, 95% CI: 0.1-1.1, p=0.063). Similarly, within patientsclassified in Sernbo-L category (n=64), those classified as highfracture risk (FRAX-H) (n=17) had significantly higher re-fracturerates compared to others in this group (n=47) (35.3% and 8.5%,respectively), (OR: 5.9; 95% CI: 1.4-24.5), (p=0.017). Multivariatelogistic regression analyses adjusting for covariates (age, sex, lengthof hospital stay and BMI) yielded similar results. Conclusion: The FAME index appears to be a useful stratificationtool for allocating patients in a randomized-controlled trial foraugmentation of hip fragility fractures.