Fracture risk assessment (which patients to assess)

Who to assess risk of fracture:

Consider assessment of fracture risk:

• in all women aged 65 years and over and all men aged 75 years and over
  
  
  
• in women aged under 65 years and men aged under 75 years in the presence of risk factors, for example:
  • previous fragility fracture
  • current use or frequent recent use of oral or systemic glucocorticoids
  • history of falls
  • family history of hip fracture
  • other causes of secondary osteoporosis
  • low body mass index (BMI) (less than 18.5 kg/m2)
  • smoking
  • alcohol intake of more than 14 units per week for women and more than 21 units per week for men

Do not routinely assess fracture risk in people aged under 50 years unless they have major risk factors (for example, current or frequent recent use of oral or systemic glucocorticoids, causes of possible secondary osteoporososis, untreated premature menopause or previous fragility fracture), because they are unlikely to be at high risk

Notes:

• causes of secondary osteoporosis include
  • endocrine (hypogonadism in either sex including untreated premature menopause and treatment with aromatase inhibitors or androgen deprivation therapy; hyperthyroidism; hyperparathyroidism; hyperprolactinaemia; Cushing's disease; diabetes),
  • gastrointestinal (coeliac disease; inflammatory bowel disease; chronic liver disease; chronic pancreatitis; other causes of malabsorption),
  • rheumatological (rheumatoid arthritis; other inflammatory arthropathies),
  • haematological (multiple myeloma; haemoglobinopathies; systemic mastocytosis),
  • respiratory (cystic fibrosis; chronic obstructive pulmonary disease),
  • metabolic (homocystinuria),
  • chronic renal disease and
  • immobility(due for example to neurological injury or disease)
    
    
    
• when considering assessing risk be aware that risk assessment tools may underestimate fracture risk in certain circumstances, for example if a person:
  • has a history of multiple fractures
  • has had previous vertebral fracture(s)
  • has a high alcohol intake
  • is taking high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)
  • has other causes of secondary osteoporosis
    
    
    
• fracture risk can be affected by factors that may not be included in the risk tool, for example living in a care home or taking drugs that may impair bone metabolism (such as anti-convulsants, selective serotonin reuptake inhibitors, thiazolidinediones, proton pump inhibitors and antiretroviral drugs
  

Reference:

• 1) NICE (February 2017). Osteoporosis: assessing the risk of fragility fracture