Osteoporosis risk and prediction of fracture

Bone mineral density (BMD) and clinical risk factors may be combined to provide a better estimate of fracture risk than BMD or clinical risk factors alone.

Fracture prediction using Fracture Risk Assessment Tool (FRAX)

The Fracture Risk Assessment Tool (FRAX) estimates the 10-year probability of hip fracture and major osteoporotic fracture for an untreated patient (40 to 90 years of age) using femoral neck BMD (g/cm2) and easily obtainable clinical risk factors for fracture.

 
FRAX is calibrated for each country using country-specific fracture data and mortality data

With the use of the FRAX model, it is anticipated that intervention will be more effectively targeted to those at highest risk of fracture, ie, older patients with slightly low T-scores and high risk of fracture will be selected for drug therapy, while fewer younger patients with low T-scores and low risk of fracture will need to be treated.

Bone mineral density

DXA measurements of hip or spine or peripheral measurements of BMD using different validated techniques can be used to predict fracture. However, T-scores derived from different skeletal sites with different technologies are not interchangeable.

We suggest DXA measurement of BMD at the hip and lumbar spine.

Assessment of clinical risk factors

The most robust non-BMD risk factors are age and prevalent fracture. Other validated BMD-independent risk factors for fracture include long-term glucocorticoid therapy, parental history of hip fracture, cigarette smoking, and excess alcohol intake