26th January 2024

Assessment of fragility fracture risk 

NICE guidelines recommend the following algorithm for the identification of high-risk patients to assess for risk of developing a fragility fracture:

• All women over the age of 65 and all men over the age of 75
• Women between the ages of 50 and 64 and men between the ages of 50-74 who have at least one of the following risk factors:
  • Personal or family history of osteoporotic fracture
  • Use of oral glucocorticoids
  • History of falls
  • Causes of secondary osteoporosis
  • Low BMI
  • Smoking
  • Alcohol intake more than 14 units per week for women and more than 21 units per week for men
  • Secondary cause of osteoporosis, e.g. rheumatological or endocrine conditions
• Men and women under the age of 50 years with any of the following risk factors:
  • Use of oral glucocorticoids
  • Untreated premature menopause
  • Previous fragility fracture
• Men and women under the age of 40 years with any of the following risk factors:
  • Use of oral glucocorticoids equivalent to, or more than, 7.5 mg prednisolone daily for 3 months or more
  • Previous fragility fracture
• Consider assessing fracture risk for patients taking certain medications, e.g. SSRIs, antiepileptics, aromatase inhibitors, PPIs, and thiazolidinediones.