The FRAIL-model: predicting the 2-year risk of hip fracture
The Fracture Risk Assessment in Long-term Care (FRAIL) model is developed to specifically identify nursing home residents at risk for hip fractures. 

The c-index differs in men (0.69) and women (0.71).
Research authors: Sarah D. Berry, Andrew R. Zullo, Yoojin Lee, Vincent Mor, Kevin W. McConeghy, Geetanjoli Banerjee, Ralph B. D'Agostino, Lori Daiello, David Dosa, and Douglas P. Kiel.
Details Formula Study characteristics Files & References
Model author
Model ID
Revision date
MeSH terms
  • Gerontology
  • Frail Elder
  • Falls
  • Nursing Homes
  • Hip Fractures
  • Model type
    Custom model (Calculation)

    Additional information

    The derivation cohort consisted of 419,668 residents between May 1, 2007 and April 30, 2008 in fee-for service Medicare. Hip fractures were identified using Part A diagnostic codes. Resident characteristics were obtained using the Minimum Data Set and Part D claims. Multivariable competing risk regression was used to model 2-year risk of hip fracture. We validated the model in a remaining 1/3 sample (n = 209,834) and in a separate cohort in 2011 (n = 858,636).

    Study Population

    Total population size: 419668
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 83.9 8.3 years
    Cognitive Performance Score 2.5 1.4 points
    BMI 26.3 6.2 kg/m2

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Race White 349500
    Black 53669
    Hispanic 7375
    Asian 3881
    Native American 1735
    Other/Unknown 3508
    ADL Hierarchy Scale Independent or Mild dependence (0-2) 132670
    Estensive assistance 1 (3) 112492
    Extensive assistance 2 (4) 79098
    Dependent (5) 80226
    Total dependence (6) 15176
    Locomotion in room Independent or supervision 132228
    Limited Assistance 69023
    Extensive Assistance 49324
    Total Dependence 169077
    Bladder continence Mostly continent 209119
    Frequent incontinence 85363
    Total incontinence 125170
    Previous fall No 252287
    Yes 167381
    Transfer performance Independent or supervision 124021
    Limited Assistance 83664
    Extensive Assistance 144313
    Total Dependence 67686
    Easily distracted No 345352
    Yes 74316
    Wandering No 382793
    Yes 36875
    Osteoarthritis No 345930
    Yes 73738
    Pressure ulcer None 391978
    Any 27690
    Medications Acetylcholinesterase inhibitors 105838
    Alpha blockers 31362
    Antidepressants - SSRI 113047
    Benzodiazepines 81356
    The FRAIL-model: predicting the 2-year risk of hip fracture
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands

    Related files

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    Supporting Publications

    Notes are only visible in the result download and will not be saved by Evidencio

    The calculated 2-year risk of hip fracture is: %

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    Outcome stratification

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    Conditional information

    Result interpretation

    The outcomes of the model could be used to screen nursing home residents for fracture risk and to target intervention strategies. 

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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