SCI-FX Risk Score Estimation and Validation: a tool to predict 5-year lower extremity fracture risk among adults with Chronic Spinal Cord Injury

Bone mass can decline up to 50% in the first 12-18 months after a spinal cord injury (SCI). Weaker bones increase the risk of fractures. Bone fractures in the hip or knee region can result in illness and increase risk of death. The key to preventing fractures is identifying individuals who have a high fracture risk and then provide them with appropriate treatment. Our objective is to develop and test an online tool called SCI-FX to identify fracture risk after SCI. We will use data from a group of Canadians living with SCI to develop the mathematical models to predict bone fractures for SCI-FX. The model will then be tested in a large group of individuals living with SCI in the United States to test if the calculations and predictions are correct. Once we show that SCI-FX works, it will be transformed into a website accessible to patients and clinicians. SCI-FX will allow clinicians or individuals living with SCI to enter their known risk factors before, during or after a routine visit, and then get an estimate of their risk of fracture in the next five years. People will be directed to appropriate therapy based on their fracture risk. As an example, individuals with low fracture risk will be advised regarding lifestyle interventions, individuals with medium fracture risk will be advised to get a bone density test, and individuals with high fracture risk will be advised to seek medical advice regarding drug therapy and exercise precautions. People at high fracture risk who need a bone density scan will be directed to get one, but SCI-FX can help to prevent travel and cost for unnecessary scans when fracture risk is low. SCI-FX will improve clinician estimation and patient knowledge regarding fracture risk, promote initiation of therapy and help prevent fracture-related death.