Open Access Study protocol

Development and validation of a population-based prediction scale for osteoporotic fracture in the region of Valencia, Spain: the ESOSVAL-R study

José Sanfélix-Genovés12*, Salvador Peiró1, Gabriel Sanfélix-Gimeno1, Vicente Giner3, Vicente Gil4, Manuel Pascual5, Carlos Fluixá6, Antonio Fuertes7, Isabel Hurtado1 and Inmaculada Ferreros1

Author Affiliations

1 Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain

2 Centro de Salud de Nazaret, Departamento de Salud 5, Agencia Valenciana de Salud, Valencia, Spain

3 Centro de Salud Ciudad Jardín, Departamento de Salud 19, Agencia Valenciana de Salud, Alicante, Spain

4 Hospital General de Elda, Departamento de Salud 18, Agencia Valenciana de Salud, Alicante, Spain

5 Agencia Valenciana de Salud, Valencia, Spain

6 Centro de Salud de Valencia Benimaclet, Departamento de Salud 5, Agencia Valenciana de Salud, Valencia, Spain

7 Centro de Salud de Alginet, Departamento de Salud 11, Agencia Valenciana de Salud, Valencia, Spain

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BMC Public Health 2010, 10:153  doi:10.1186/1471-2458-10-153

Published: 24 March 2010



Today, while there are effective drugs that reduce the risk of osteoporotic fracture, yet there are no broadly accepted criteria that can be used to estimate risks and decide who should receive treatment. One of the actual priorities of clinical research is to develop a set of simple and readily-available clinical data that can be used in routine clinical practice to identify patients at high risk of bone fracture, and to establish thresholds for therapeutic interventions. Such a tool would have high impact on healthcare policies. The main objective of the ESOSVAL-R is to develop a risk prediction scale of osteoporotic fracture in adult population using data from the Region of Valencia, Spain.


Study design: An observational, longitudinal, prospective cohort study, undertaken in the Region of Valencia, with an initial follow-up period of five years; Subjects: 14,500 men and women over the age of 50, residing in the Region and receiving healthcare from centers where the ABUCASIS electronic clinical records system is implanted; Sources of data: The ABUCASIS electronic clinical record system, complemented with hospital morbidity registers, hospital Accidents & Emergency records and the Regional Ministry of Health's mortality register; Measurement of results: Incident osteoporotic fracture (in the hip and/or major osteoporotic fracture) during the study's follow-up period. Independent variables include clinical data and complementary examinations; Analysis: 1) Descriptive analysis of the cohorts' baseline data; 2) Upon completion of the follow-up period, analysis of the strength of association between the risk factors and the incidence of osteoporotic fracture using Cox's proportional hazards model; 3) Development and validation of a model to predict risk of osteoporotic fracture; the validated model will serve to develop a simplified scale that can be used during routine clinical visits.


The ESOSVAL-R study will establish a prediction scale for osteoporotic fracture in Spanish adult population. This scale not only will constitute a useful prognostic tool, but also it will allow identifying intervention thresholds to support treatment decision-making in the Valencia setting, based mainly on the information registered in the electronic clinical records.