Identifying and targeting patients at high risk of fracture, uni- and multi-variate analyses indicate age, prior fracture history, and bone mineral density (BMD) as the strongest fracture risk predictors [1]Kanis, J.A., et al., Assessment of fracture risk. Osteoporos Int, 2005. 16(6): p. 581-9.

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Age and female gender are some of the predominant risk factors for osteoporosis. It is clear that the elderly, in comparison with young adults, are at a significantly higher risk of osteoporosis and fracture [2]Rizzoli, R., et al., Management of osteoporosis of the oldest old. Osteoporos Int, 2014. 25(11): p. 2507-29.

and that women are at higher risk than men for osteoporosis and fracture(s) [3]Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.

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Other factors including low BMD, susceptibility to falls and previous fragility fractures all also contribute to a higher fracture risk [3]Hernlund, E., et al., Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013. 8: p. 136.

[4]Johnell, O., et al., Fracture risk following an osteoporotic fracture. Osteoporos Int, 2004. 15(3): p. 175-9.

[5]Lloyd, B.D., et al., Recurrent and injurious falls in the year following hip fracture: a prospective study of incidence and risk factors from the Sarcopenia and Hip Fracture study. J Gerontol A Biol Sci Med Sci, 2009. 64(5): p. 599-609.

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In fact, the occurrence of a previous fracture as a risk factor for future fracture has been well documented. It has been shown that for women between the ages of 50 and 80, following a first fragility fracture, their subsequent fracture risk within the first year after the initial event is five times greater than women who have not had a prior fracture [6]van Geel, T.A., et al., Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis, 2009. 68(1): p. 99-102.

[7]Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780.

. The risk of a subsequent fracture is highest in the first 2 years after an initial fracture, when there is an imminent risk of another fracture at the same, or other, sites [7]Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780.

[8]Kanis, J.A., et al., Characteristics of recurrent fractures. Osteoporos Int, 2018. 29(8): p. 1747-1757.

. This future fracture risk then decreases with time [4]Johnell, O., et al., Fracture risk following an osteoporotic fracture. Osteoporos Int, 2004. 15(3): p. 175-9.

[7]Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780.

[9]Johnell, O., et al., Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int, 2001. 12(3): p. 207-14.

[10]Ryg, J., et al., Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res, 2009. 24(7): p. 1299-307.

 as shown in the Reykjavik study, where major osteoporotic fracture (MOF) risk following an initial MOF was 2.7 time higher in comparison to the population risk at 1 year and declined to 1.4 times at 10 years [7]Johansson, H., et al., Imminent risk of fracture after fracture. Osteoporos Int, 2017. 28(3): p. 775-780.

. Management of these patients is crucial and specific models of care  have been established to try and minimise the occurrence of a second fracture.

• Capture the Fracture: Secondary Fracture Prevention

Finally, medical conditions or medications  that can induce osteoporosis by bone loss, by directly or indirectly affecting bone remodelling or interfering with the attainment of peak bone mass in younger individuals also increase fracture risk. Read more about secondary osteoporosis.

• Obtain a complete medical history in particular any prior low-energy fractures (fragility fractures);
• Assess all risk factors that contribute to osteoporosis and fragility fractures including medical conditions or medication(s) taken by the patient;
• Use the fracture risk assessment tool FRAX^®  that calculates the 10-year probabilities of MOF and of hip fracture alone;
• Assess BMD by dual-energy X-ray absorptiometry (DXA)  at spine or hip.