Fracture risk assessment in postmenopausal women
First Online: 02 October 2009 DOI:
Cite this article as: Hamdy, R.C. Rev Endocr Metab Disord (2010) 11: 229. doi:10.1007/s11154-009-9118-4 Abstract
Patients with osteoporosis have an increased risk of sustaining fractures because of the low bone mineral density (BMD) and altered bone micro-architecture which are characteristic features of the disease. Although a good correlation exists between BMD and fracture risks, many other factors influence this relationship. While there is consensus that patients with osteoporosis should be investigated and treated, the issue is much less clear for patients with osteopenia. Because osteopenia is so prevalent, it would be unrealistic to treat all patients with this condition. Therefore, there is a need to identify those patients who are at risk of sustaining a fracture and would benefit most from the available therapy. Providing treatment to the appropriate risk group would not only reduce the number of fractures, but could also reduce the adverse effects associated with treatment, as treating patients earlier could shorten the treatment time. The availability of tools to select patients at risk of fracture should change the impact of the disease.
Keywords Fracture risk assessment FRAX® Osteoporosis Treatment guidelines References
NIH Consensus Development Panel. JAMA. 2001;285:785–95.
Kanis JA, Melton LJ III, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9:1137–41.
National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington DC: National Osteoporosis Foundation; 2008.
Kanis JA, Johnell O, Oden A. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989–95.
Robbins JA, Schott AM, Garnero P, et al. Risk factors for hip fracture in women with high BMD: EPIDOS study. Osteoporos Int. 2005;16:149–54.
Silverman S. Selecting patients for osteoporosis therapy. J Bone Miner Res. 2009;24:765–7.
Pluijm SM, Koes B, de Laet C, et al. A simple risk score for the assessment of absolute fracture risk in general practice based on two longitudinal studies. J Bone Miner Res. 2009;24:768–74.
Diez-Perez A, Gonzàlez-Macias J, Marin F, et al. Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound. Osteoporos Int. 2007;18:629–39.
Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721–39.
Ribot C, Temollieres F, Pouilles JM. Can we detect women with low bone mass using clinical risk factors? Am J Med. 1995;98(2A):52S–5.
Robbins J, Aragaki AK, Kooperberg C, et al. Factors associated with 5-year risk of hip fracture in postemenopausal women. JAMA. 2007;298:2389–98.
Sornay-Rendu E, Munoz F, Garnero P, et al. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res. 2005;20:1813–9.
van Staa TP, Geusens P, Kanis JA, et al. A simple clinical score for estimating the long-term risk of fracture in postmenopausal women. QJM. 2006;99:673–82.
Kanis JA, Oden A, Johansson H, et al. FRAX and its application to clinical practice. Bone. 2009;44:732–43.
Piirtola M, Vahlberg T, Löppönen M, et al. Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow up. Eur J Epidemiol. 2008;23:747–55.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21.
Holroyd C, Cooper C, Dennison E. Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab. 2008;22:671–85.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.
Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137:1001–5.
Wehren LE, Magaziner J. Hip fracture: risk factors and outcomes. Curr Osteoporos Rep. 2003;1:78–85.
Pande I, Scott DL, O’Neill TW, Pritchard C, et al. Quality of life, morbidity and mortality after low trauma hip fracture in men. Ann Rheum Dis. 2006;65:87–92.
Bass E, French DD, Bradham DD, et al. Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol. 2007;17:514–9.
Davidson CW, Merilees MJ, Wilkinson TJ, et al. Hip fracture mortality and morbidity – can we do better? N Z Med J. 2001;114:329–32.
Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320–3.
Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34:195–202.
Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–9.
Faulkner KG. Bone matters: are density increases necessary to reduce fracture risk? J Bone Miner Res. 2000;15:183–7.
Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282:637–45.
Melton LJ III, Ilstrup DM, Beckenbaugh RD, et al. Hip fracture recurrence. A population-based study. Clin Orthop Relat Res. 1982;167:131–8. Clin Ortho Res 1982;167:131.
van Staa TP, Leufkens HG, Cooper C. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int. 2002;13:624.
Kanis JA, Johnell O, DeLaet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375–82.
Pongchaiyakul C, Nguyen ND, Jones G, et al. Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res. 2005;20:1349–55.
Siris ES, Bilezekian JP, Rubin MR, et al. Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab. 2003;88:3482–6.
Bahl S, Coates PS, Greenspan SL. The management of osteoporosis following hip fracture: have we improved our care? Osteoporos Int. 2003;14:884–8.
Cree MW, Juby AG, Carriere KC. Mortality and morbidity associated with osteoporosis drug treatment following hip fracture. Osteoporos Int. 2003;14:722–7.
Lyles KW, Schenck AP, Colon-Emeric CS. Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents. Osteoporos Int. 2008;19:1225–33.
Tosi LL, Gliklich R, Kannan K, et al. The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90:163–73.
Gregory JS, Aspden RM. Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys. 2008;30:1275–86.
Garnero P, Hausherr E, Chapuy MC, et al. Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study. J Bone Miner Res. 1996;11:1531–8.
Johnell O, Oden A, DeLaet C, et al. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int. 2002;13:523–6.
Delmas PD, Eastell R, Garnero P, et al. Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int. 2000;11(Suppl 6):S2–17.
DeLaet CE, Van Hout BA, Burger H, et al. Hip fracture prediction in elderly men and women: validation in the Rotterdam study. J Bone Miner Res. 1998;13:1587–93.
DeLaet CE, Van der Klift M, Hofman A, et al. Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res. 2002;17:2231–6.
Hochberg MC. Racial differences in bone strength. Trans Am Clin Climatol Assoc. 2007;118:305–15.
Kanis JA, Borstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporosis Int. 2005;16:581–9.
LaFleur J, McAdam-Marx C, Kirkness C, et al. Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature. Ann Pharmacother. 2008;42(3):375–86.
DeLaet C, Kanis JA, Ogden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–8.
Papaioannou A, Kennedy CC, Cranney A, et al. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int. 2009;20:507–18.
Waugh EJ, Lam MA, Hawker GA, et al. Risk factors for low bone mass in healthy 40–60 year old women: a systematic review of the literature. Osteoporos Int. 2009;20:1–21.
Stolee P, Poss J, Cook RJ, et al. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Med Sci. 2009;64:403–10.
Rothem DE, Rothem L, Soudry M, et al. Nicotine modulates bone metabolism-associated gene expression in osteoblast cells [published online ahead of print May 13, 2009]. J Bone Miner Metab. 2009.
. Accessed May 2009.
Lim LS, Fink Ha, Kuskowski MA, et al. Osteoporotic fractures in men (MrOS) study group. Loop diuretic use and increased rates of hip bone loss in older men: the osteoporotic fractures in men study. Arch Intern Med. 2008;168:735–40.
Fitzpatrick LA. Pathophysiology of bone loss in patients receiving anticonvulsant therapy. Epilepsy Behav. 2004;5(Suppl 2):S3–15.
Kanis JA, Johnell O, Oden A, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:385–97.
Hamdy RC, Kiebzak GM. Variance in 10-year fracture irsk calculated with and without T-scores in select subgroups of normal and osteoporotic patients. J Clin Densitom. 2009;12:158–61.
Hamdy RC. FRAX
®: a fracture risk assessment tool. Aging Health. 2009;5:489–494.
Borgström F, Johnell O, Kanis JA, et al. At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis. Osteoporos Int. 2006;17:1459–71.
Dawson-Hughes B, Tosteson AN, Melton LJ III, et al. National Osteoporosis Foundation Guide Committee. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19:449–58.
Tosteson AN, Melton LJ III, Dawson-Hughes B, et al. National Osteoporosis Foundation Guide Committee. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19:437–47.
CrossRef PubMed Copyright information
© Springer Science+Business Media, LLC 2009