Journal article
Development and external validation of prediction models for major osteoporotic fracture and hip fracture in people with intellectual disability
- Abstract:
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Purpose
Compared with the general population, people with intellectual disabilities (ID) have higher incidences of major osteoporotic fracture (MOF) and hip fracture (HF), and osteoporosis develops at a younger age. The rate of HF in those aged 50 years and over is two and four times higher than that in women and men, respectively, without ID. It is essential to identify people with ID at risk of such fractures so that a targeted fracture prevention strategy can be designed. However, current fracture prediction models are derived from the general population and may underestimate risk in the ID population.
Methods
Prediction models (IDFracture) for the 10-year risk of HF and MOF were developed and validated in populations of people with ID aged 30-79 years. Models were developed in the CPRD GOLD database and temporally validated in the Aurum database. The predictors included those in current fracture prediction models and IDspecific predictors such as Down syndrome. All the predictors were included in the Cox regression models. Bootstrapping was used to adjust for overfitting.
Results
The development cohort included 38,665 people with IDs, 1045 with MOFs and 360 with HFs within 10 years. The external validation cohort included 76,385 people, 2420 MOFs and 1001 HFs. Discrimination, as judged by the C statistic, was good: MOF 0.775, HF 0.839. The calibration was also good but tended to overpredict at the highest predicted risks.
Conclusion
IDFracture has potential as a screening tool in clinical practice to identify people with ID who are at increased risk of MOF and HF.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.3MB, Terms of use)
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(Preview, Supplementary materials, pdf, 2.3MB, Terms of use)
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- Publisher copy:
- 10.1007/s00198-026-07848-3
Authors
+ National Institute for Health and Care Research
More from this funder
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- PB-PG-1216-20017
- NIHR202094
- Publisher:
- Springer
- Journal:
- Osteoporosis International More from this journal
- Volume:
- 37
- Issue:
- 4
- Pages:
- 915–925
- Publication date:
- 2026-04-20
- Acceptance date:
- 2025-09-01
- DOI:
- EISSN:
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1433-2965
- ISSN:
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0937-941X
- Language:
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English
- Keywords:
- Pubs id:
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2405161
- Local pid:
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pubs:2405161
- Deposit date:
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2026-04-12
- ARK identifier:
Terms of use
- Copyright holder:
- Smith et al.
- Copyright date:
- 2026
- Rights statement:
- © The Author(s) 2026. Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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