Effect of competing mortality risks on predictive performance of the QFracture-2012 risk prediction tool for major osteoporotic fracture and hip fracture: external validation cohort study in a UK primary care population
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  • Published on:
    External valdiation of QFracture-2012
    • Julia Hippisley-Cox, Professor of Clinical Epidemiology University of Oxford
    • Other Contributors:
      • Carol Coupland, professor of medical statistics

    As authors of the QFracture papers1-3, we read this article by Livingstone et al with interest. They stated that the had externally validated the QFracture-2016 algorithm using CPRD4. The authors report that whilst there was very good to excellent discrimination, calibration was poor. The authors attributed an apparent under-prediction to their outcome definition using the CPRD validation dataset since this included GP data linked to hospital data. However, we think this under-prediction is due to the authors using the wrong algorithm – the authors have confirmed that they had used a previous version (QFracture-2012) which is based on unlinked data. The QFracture-2016 algorithm is the version which is currently recommended and used in the NHS and is derived from the QResearch database including GP data linked to hospital and mortality data3. Therefore, the authors need to correct their paper and update their conclusions accordingly. We would also like to highlight that the code groups for QFracture are available here
    1. Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: Prospective derivation and validation of QFractureScores. BMJ (Online) 2009;339(7733):1291-95. doi: 10.1136/bmj.b4229
    2. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorith...

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    Conflict of Interest:
    Julia Hippisley-Cox is professor at the university of Oxford, lead academic for the development of the QFracture score, founder, shareholder and former clinical director of ClinRisk Ltd (which produces open and closed source software to implement risk prediction algorithms in the NHS). Carol Coupland of professor at the university of Nottingham and senior research fellow at the university of Oxford and consultant statistician for ClinRisk Ltd.