View / Download pdf version of this article

Based on FRAX: www.shef.ac.uk/FRAX

No BMD Measurement Available

Step 1: Assess patient for presence of Clinical Risk Factors.

Clinical risk factors  
  • Previous fragility fracture, particularly of the hip, wrist and spine including radiographic evidence of 20% loss of height of a vertebral body
  • Parental history of hip fracture
  • Current glucocorticoid treatment (any dose, by mouth for 3 months or more)
  • Current smoking
  • Alcohol intake of 3 or more units daily
  • Secondary causes of osteoporosis including:
    • Rheumatoid arthritis
    • Untreated hypogonadism in men and women
    • Prolonged immobility
    • Organ transplantation
    • Type 1 diabetes
    • Hyperthyroidism
    • Gastrointestinal disease
    • Chronic liver disease
    • Chronic obstructive pulmonary disease

Step 2: Use the tables to calculate the 10 year probability (%) of major osteoporotic fracture risk based on age, gender, BMI and number of clinical risk factors.

MEN with or without previous fracture

No of CRFs Age 50
0 2.9 2.8 2.8 2.4 2.1
1 4.5 4.3 4.3 3.7 3.3
2 7.1 6.7 6.5 5.7 4.9
3 11 10 9.7 8.5 7.4
  15 20 25 30 35
  BMI
No of CRFs Age 60
0 4.2 4.0 3.9 3.4 2.9
1 6.5 6.1 6.0 5.2 4.5
2 10 9.3 8.9 7.7 6.7
3 15 14 13 11 9.9
  15 20 25 30 35
  BMI
No of CRFs Age 70
0 6.0 5.8 5.7 4.8 4.1
1 9.0 8.5 8.2 6.9 5.9
2 13 12 12 9.9 8.4
3 20 18 17 14 12
  15 20 25 30 35
  BMI
No of CRFs Age 80
0 7.8 7.4 7.2 5.9 4.8
1 12 11 11 8.7 7.1
2 19 17 16 13 10
3 27 25 23 19 15
  15 20 25 30 35
  BMI

WOMEN with no previous fracture*

No of CRFs Age 50
0 3.9 3.6 3.5 3.0 2.6
1 6.3 5.7 5.4 4.7 4.1
2 9.9 8.8 8.2 7.2 6.3
3 15 13 12 11 9.5
  15 20 25 30 35
  BMI
No of CRFs Age 60
0 7.4 6.5 6.0 5.2 4.6
1 12 10 9.3 8.1 7.0
2 18 15 14 12 11
3 27 23 20 18 16
  15 20 25 30 35
  BMI
No of CRFs Age 70
0 14 12 11 9.5 8.2
1 21 18 16 14 12
2 31 26 23 20 17
3 44 37 32 28 24
  15 20 25 30 35
  BMI
No of CRFs Age 80
0 22 19 17 15 12
1 32 28 25 21 18
2 44 40 35 30 25
3 56 52 47 41 35
  15 20 25 30 35
  BMI

Step 3: Intervention thresholds

    Reassure   Consider BMD test   Consider Treatment

BMD Measurement Available

Step 1: Assess patient for presence of Clinical Risk Factors.

Clinical risk factors  
  • Previous fragility fracture, particularly of the hip, wrist and spine including radiographic evidence of 20% loss of height of a vertebral body
  • Parental history of hip fracture
  • Current glucocorticoid treatment (any dose, by mouth for 3 months or more)
  • Current smoking
  • Alcohol intake of 3 or more units daily
  • Secondary causes of osteoporosis including:
    • Rheumatoid arthritis
    • Untreated hypogonadism in men and women
    • Prolonged immobility
    • Organ transplantation
    • Type 1 diabetes
    • Hyperthyroidism
    • Gastrointestinal disease
    • Chronic liver disease
    • Chronic obstructive pulmonary disease

Step 2: Use the tables to calculate the 10 year probability (%) of major osteoporotic fracture risk based on age, gender, BMD and number of clinical risk factors.

MEN with or without previous fracture

No of CRFs Age 50
1 30 14 7.5 5.1 4.0
2 43 20 11 7.5 5.9
3 57 29 16 11 8.4
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 60
1 31 16 9.6 6.4 5.0
2 41 23 14 9.2 7.1
3 53 31 19 13 10
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 70
1 28 17 11 7.2 5.6
2 37 24 15 9.9 7.5
3 48 32 20 13 10
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 80
1 23 16 10 7.0 5.3
2 32 22 15 10 7.3
3 42 31 21 14 10
  -4 -3 -2 -1 0
  BMD

WOMEN with no previous fracture*

No of CRFs Age 50
1 26 13 7.6 5.5 4.8
2 37 19 11 8.1 7.0
3 51 27 16 12 10
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 60
1 32 18 11 8.0 6.8
2 44 25 16 12 9.8
3 58 35 23 16 14
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 70
1 41 25 15 11 8.9
2 54 34 21 15 12
3 67 45 29 20 16
  -4 -3 -2 -1 0
  BMD
No of CRFs Age 80
1 45 29 19 13 9.6
2 57 40 26 18 13
3 67 51 35 25 17
  -4 -3 -2 -1 0
  BMD

Step 3: Intervention thresholds

    Reassure   Consider Treatment   Strongly Recommend Treatment