Derivation and validation of the QFracture algorithm to predict risk of osteoporotic fracture

What is the aim of the study and why is it important?

QFracture is a risk prediction algorithm which calculates an individual’s risk of osteoporotic fracture taking account of their individual risk factors such as age, sex, ethnicity, clinical values and diagnoses. Osteoporotic fracture is identified according to clinical codes recorded on the primary care record or the linked mortality or hospital record. The research describing the derivation and validation of different versions of QFracture has been published in the BMJ.

QFracture is used to quantify an individual’s risk of having an osteoporotic fracture in the next 10 years in order to prioritise and inform decisions regarding interventions to lower risk. It is recommended by NICE as the risk score for use in its guidance on prevention of fragility fracture. It is used as a measure in the GP contract. It is updated regularly to ensure the algorithms remain calibrated to the current population since the incidence of disease and the prevalence of risk factors change over time. The updates also enable the algorithm to take account of improvements to data quality (for example increases in the completeness of recording of risk factors such as ethnicity or laboratory values) and also allows adaptations to any changes which might be required to improve the predictive power of the tool or the population to which is applied.

Chief Investigator

Julia Hippisley-Cox



Location of research


Date on which research approved


Project reference ID


Generic ethics approval reference


Are all data accessed are in anonymised form?


Brief summary of the dataset to be released (including any sensitive data)

Risk factors for osteoporotic fracture linked to outcomes (hip, knee, wrist and spine fracture) on either GP, hospital or mortality records

Funding Source

No external funding

Research Team

Julia Hippisley-Cox, Carol Coupland


  • Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study
    Authors: Hippisley-Cox J, Coupland C
    Ref: BMJ 2012;344:e3427
  • Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFracture Scores
    Authors: Hippisley-Cox J, Coupland C
    Ref: BMJ 2009:339:b4229

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