Effect of competing mortality risks on predictive performance of the QFracture risk prediction tool for major osteoporotic fracture and hip fracture: external validation cohort study in a UK primary care population.

The QFracture risk prediction tool systematically under-predicted the risk of fracture (because of incomplete determination of fracture rates) and over-predicted the risk in older people and in those with more comorbidities (because of competing mortality). The use of QFracture in its current form needs to be reviewed, particularly in people at high risk of death from other causes.