(ii) Fracture risk assessment

SummaryOsteoporotic fractures cause excess mortality, substantial morbidity and health and social service expenditure in older people. The risk of these fractures is determined by skeletal factors, including bone mineral density (BMD), bone turnover, architecture, bone size, and skeletal geometry, together with non-skeletal factors associated with falling. With the advent of treatments which decrease the incidence of fractures and the development of strategies for preventing falls, there is growing interest in identifying people at high risk of fragility fractures, in whom to target therapeutic intervention. The World Health Organization (WHO) has recently developed a Fracture Risk Assessment Tool (FRAX™). This uses clinical risk factors, including prior fracture after age of 50 years, parental hip fracture, current smoking, oral steroid therapy, alcohol intake >2 units/day and chronic conditions such as rheumatoid arthritis, with or without femoral neck BMDt, to estimate the ten year probability of hip and other major osteoporotic fractures.