Osteoporosis fracture risk assessment

Osteoporotic fractures pose a significant burden on society and the healthcare system worldwide. Unless there is a known fragility fracture, the diagnosis of osteoporosis is based on the World Health Organization (WHO) T-score criteria using central dual-energy X-ray absorptiometry (DXA). A large number of patients, however, who suffer from a low-trauma fracture, do not meet the T-score definition of osteoporosis. Conversely, younger individuals with bone mineral density in the osteoporotic range without other risk factors often have low fracture risk, but are commonly prescribed osteoporosis therapies. Bone mineral density is an important measure of fracture risk but has low sensitivity and low positive predictive value for fractures, resulting in the development of fracture risk assessment tools such as FRAX®. FRAX utilises bone mineral density and clinical risk factors to assess 10-year probability of major osteoporosis-related and hip-related fracture risk. FRAX is being used in a growing number of countries worldwide to define cost-effective intervention strategies for primary and secondary fracture prevention.