GeRi-Score Predicts Post-Femur Fracture Mortality Risk in Older Adults

The GeRi-Score can be used as a benchmark tool in quality management programs.

The Geriatrics at Risk (GeRi) Score is accurate in predicting mortality risk post-femur fracture in among older adults, according to research published in Osteoporosis International.

Researchers conducted a retrospective registry study using information from the Registry of Geriatric Trauma (ATR-DGU) database, a leading treatment center for older adult patients with proximal femur fractures. Participants (N=19,054) included in the study were aged 70 years and older and sustained a proximal femur fracture that required surgical treatment between 2017 and 2019. The primary outcome was in-house mortality.

All statistical calculations performed using statistics software R version 4.1.2. In developing the simplified risk score, a basic model was first developed using the American Society of Anesthesiologists grade score, simplified into 3 categories—grades 1 and 2, grade 3, grades 4 and 5. Thereafter, multiple models were created individually using covariates from ATR-DGU database (ie, age and concomitant injuries). All models created were compared using Akaike information criteria.

Comparison models culminated in the development of GeRi-Score, which was calculated using ASA grade, gender, age, anticoagulation status, concomitant injuries and place of fracture. It consisted of a point system with precision of 0.5 which can range from 0 to 20 points.

The GeRi- Score might have the potential to distribute and calculate the intensity of medical care and orthogeriatric co-management.

Upon validating GeRi-Score, the area under the curve for validation data was 0.718 (95% CI, 0.703-0.733). Predicted mortality was found to be 5.4% compared with observed mortality of 5.7%. Additionally, the GeRi-Score was able to accurately predict mortality compared with observed mortality, notably in patients at moderate to high risk, of whom comprised 80% of the dataset.

Limitations of the study include selection bias due to the retrospective registry study design, as well as confounding data.

The study authors conclude, “The GeRi- Score might have the potential to distribute and calculate the intensity of medical care and orthogeriatric co-management. Furthermore, it could be used in quality management programs and as a benchmark tool to optimize procedures in hip fracture care.”


Schoeneberg C, Heuser L, Rascher K, et al. The Geriatrics at Risk Score (GeRi-Score) for mortality prediction in geriatric patients with proximal femur fracture – a development and validation study from the Registry for Geriatric Trauma (ATR-DGU). Osteoporos Int. Published online March 9, 2023. doi:10.1007/s00198-023-06719-5