Osteoporotic fracture risk prediction tools

Abstract

The therapeutic approach of the osteoporosis aims an impact not only on the bone mineral density (BMD), but also on the fracture risk. Fracture risk is defined as a 10-year absolute risk in %. The principles for fracture risk assessment are defined. Age and BMD are initial points of its calculation. A 10-year absolute risk of fractures is assessed on the basis of a table or nomogram. Each serious risk factor such as pre-existing fracture (vertebral or hip), low body mass index (below 20 kg/m2), heredity for hip fractures, high doses of corticosteroid therapy, etc. is accompanied by a doubling of the absolute fracture risk. The process of osteoporotic fracture risk assessment involves several stages: depth anamnesis, physical examination, BMD test, X-ray analysis of vertebral fractures and laboratory tests to exclude secondary cause of osteoporosis. The obtained data can be input into each of the methods for assessing the risk of fractures. Simple screening tools for fracture prediction are OST, ORAI, OSIRIS, SCORE and age alone. Other widely used methods are FRAX®, a Garvan risk calculator and QFracture®. Diff erences in the introduced variables create significant variations in calculated risks from each calculator. The decision on the type of the risk calculator can be made on the basis of country-specific features, although it is necessary for the physician to be aware of the limitations of the chosen method. The complex infl uence on the fracture risk can be achieved through an integrated multidisciplinary approach. The aim is achievement of real outcomes in the prevention of osteoporosis before the occurrence of the first osteoporotic fracture to reduce the expansion of the disease and its negative effects.