Osteoporosis International

, Volume 19, Issue 4, pp 449–458

Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA

  • B. Dawson-Hughes
  • A. N. A. Tosteson
  • L. J. MeltonIII
  • S. Baim
  • M. J. Favus
  • S. Khosla
  • R. L. Lindsay
Special Position Paper

DOI: 10.1007/s00198-008-0559-5

Cite this article as:
Dawson-Hughes, B., Tosteson, A.N.A., Melton, L.J. et al. Osteoporos Int (2008) 19: 449. doi:10.1007/s00198-008-0559-5



Application of the WHO fracture prediction algorithm in conjunction with an updated US economic analysis indicates that osteoporosis treatment is cost-effective in patients with fragility fractures or osteoporosis, in older individuals at average risk and in younger persons with additional clinical risk factors for fracture, supporting existing practice recommendations.


The new WHO fracture prediction algorithm was combined with an updated economic analysis to evaluate existing NOF guidance for osteoporosis prevention and treatment.


The WHO fracture prediction algorithm was calibrated to the US population using national age-, sex- and race-specific death rates and age- and sex-specific hip fracture incidence rates from the largely white population of Olmsted County, MN. Fracture incidence for other races was estimated by ratios to white women and men. The WHO algorithm estimated the probability (%) of a hip fracture (or a major osteoporotic fracture) over 10 years, given specific age, gender, race and clinical profiles. The updated economic model suggested that osteoporosis treatment was cost-effective when the 10-year probability of hip fracture reached 3%.


It is cost-effective to treat patients with a fragility fracture and those with osteoporosis by WHO criteria, as well as older individuals at average risk and osteopenic patients with additional risk factors. However, the estimated 10-year fracture probability was lower in men and nonwhite women compared to postmenopausal white women.


This analysis generally endorsed existing clinical practice recommendations, but specific treatment decisions must be individualized. An estimate of the patient’s 10-year fracture risk should facilitate shared decision-making.


Fracture prediction National Osteoporosis Foundation Osteoporosis Practice guidelines World Health Organization 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • B. Dawson-Hughes
    • 1
  • A. N. A. Tosteson
    • 2
    • 8
  • L. J. MeltonIII
    • 3
  • S. Baim
    • 4
  • M. J. Favus
    • 5
  • S. Khosla
    • 6
  • R. L. Lindsay
    • 7
  1. 1.Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonUSA
  2. 2.Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth Medical SchoolLebanonUSA
  3. 3.Division of Epidemiology, College of MedicineMayo ClinicRochesterUSA
  4. 4.The Medical College of WisconsinMilwaukeeUSA
  5. 5.Department of MedicineUniversity of ChicagoChicagoUSA
  6. 6.Division of Endocrinology, College of MedicineMayo ClinicRochesterUSA
  7. 7.Helen Hayes HospitalRegional Bone CenterWest HaverstrawUSA
  8. 8.HB7505 Clinical Research, Dartmouth Medical SchoolOne Medical Center DriveLebanonUSA

Personalised recommendations