Risk assessment of fragility fracture: NICE guideline

Abstract

Fragility fractures result from mechanical forces that would not ordinarily result in fracture. The World Health Organization (WHO) has quantified this as forces equivalent to a fall from a standing height or less. Reduced bone density is a major risk factor for fragility fractures. The prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years. There are a number of pharmacological treatments available for the primary or secondary prevention of fragility fractures. These primarily target bone loss and assessment for treatment has largely been based on the measurement of bone mineral density (BMD). However, the majority of fragility fractures occur in people who do not have osteoporosis. Factors, including lifestyle factors such as smoking and high alcohol intake, the use of oral or systemic glucocorticoids, sex, previous fractures, and disorders such as rheumatoid arthritis all increase the risk of fragility fracture. This new guideline from NICE assesses the value of risk prediction tools, with and without BMD, for prediction of fracture risk.1 The guideline …