Condition

Risk Factors for Hip Fracture

Editors: Mark G. Siegel MD; Alan Ehrlich MD, FAAFP

References

General References Used

The references listed below are used in this DynaMed topic primarily to support background information and for guidance where evidence summaries are not felt to be necessary. Most references are incorporated within the text along with the evidence summaries.

  1. LeBlanc KE, Muncie HL Jr, LeBlanc LL. Hip fracture: diagnosis, treatment, and secondary prevention. Am Fam Physician. 2014 Jun 15;89(12):945-51.

Recommendation Grading Systems Used

  • American Academy of Neurology (AAN) grading system for recommendations
    • levels of evidence
      • Level A - established as effective, ineffective, or harmful (or established as useful/predictive or not useful/predictive) for given condition in specified population
        • requires at least 2 consistent Class I studies
        • in exceptional cases, one convincing Class I study may suffice for an "A" recommendation if all criteria met and magnitude of effect is large (relative rate improved outcome > 5 and lower limit of confidence interval > 2)
      • Level B - probably effective, ineffective, or harmful (or probably useful/predictive or not useful/predictive) for given condition in specified population (requires at least 1 Class I study or at least 2 consistent Class II studies)
      • Level C - possibly effective, ineffective, or harmful (or possibly useful/predictive or not useful/predictive) for given condition in specified population (requires at least 1 Class II study or at least 2 consistent Class III studies)
      • Level U - data inadequate or conflicting; given current knowledge, treatment (test, predictor) is unproven (studies not meeting criteria for Class I-III)
    • classifications of evidence for prognostic interventions
      • Class I study
        • prospective study of broad spectrum of persons who may be at risk for developing outcome (such as target disease, work status)
        • measures predictive ability using independent gold standard for case definition
        • predictor measured in evaluation masked to clinical presentation and outcome measured in evaluation that masked to presence of predictor
        • all patients have predictor and outcome variables measured
      • Class II study
        • prospective study of narrow spectrum of persons at risk for having condition, or by retrospective study of broad spectrum of persons with condition compared to broad spectrum of controls
        • study measures predictive ability using acceptable independent gold standard for case definition
        • outcome, if not objective, determined by someone other than person who measured predictor
      • Class III study
        • evidence provided by retrospective study where either persons with condition or controls are of a narrow spectrum
        • measures predictive ability using acceptable independent gold standard for case definition
        • outcome, if not objective, determined by someone other than person who measured predictor
      • Class IV study - any design where the predictor is not applied in an independent evaluation OR evidence provided by expert opinion or case series without controls
    • Reference - AAN practice parameter on assessing patients for risk of falls (Neurology 2008 Feb 5;70(6):473), commentary can be found in Neurology 2009 Jan 27;72(4):382

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and adhere to evidence-based methodology and inclusive language standards.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partner, McMaster University.

Special Acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the DynaMed internal Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

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DynaMed Levels of Evidence

Quickly find and determine the quality of the evidence.

DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.

Download the full version of Levels of Evidence