REVIEW Assessment of fracture risk

Abstract The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide informa-tion on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distin-guished from diagnosis to take account of the indepen-dent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip frac-ture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The indepen-dent contribution of these risk factors can be integrated by the calculation of fracture probability with or with-out the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold