Validation of the Cummings' risk score; how well does it identify women with high risk of hip fracture: the Tromsø Study

Eur J Epidemiol. 2006;21(11):815-22. doi: 10.1007/s10654-006-9072-3. Epub 2006 Nov 22.


Objective: We examined a two-step case-finding strategy where the Cummings' risk score (NEJM 1995) was applied in a population-based setting together with bone mineral density (BMD) measurements in order to validate its ability to identify women with high risk of hip fracture.

Methods: All Tromsø women aged between 65 and 74 were invited to the Tromsø Osteoporosis Study (TROST) together with a 5% random sample of women aged 75-84 years (n = 1410). All had forearm BMD measurements in 1994/95 and were followed for 5 years with respect to first hip fracture. A risk score was constructed matching the Cummings score as closely as possible.

Results: In all 759, 578 and 73 women had 0-2, 3-4 and 5+ risk factors, respectively. Women with 5+ risk factors had a 5-year hip fracture risk of 11% (95% confidence interval (CI) 3.7-18.2%). BMD screening applied to these women identified 74% of them as osteoporotic and 19% as osteopenic with, respectively, 5-year hip fracture risk of 13% and 7.1%.

Conclusion: In a population different from the one the score was generated in, this simple risk score identifies a group of women with high risk of hip fractures. With no additional BMD measurements, those high-risk women could benefit from early intervention measures.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Weight
  • Bone Density / physiology*
  • Cohort Studies
  • Female
  • Hip Fractures / etiology*
  • Hip Fractures / pathology
  • Hip Fractures / physiopathology
  • Hip Fractures / prevention & control
  • Humans
  • Mass Screening / methods*
  • Osteoporosis, Postmenopausal / complications*
  • Osteoporosis, Postmenopausal / physiopathology
  • Random Allocation
  • Risk Assessment / methods
  • Risk Factors