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How should fracture risk be assessed?

How should fracture risk be assessed?

There are different ways in which fracture risk can be assessed.

Assessment tools

If you have been offered an assessment of fracture risk, your healthcare professional should use an 'assessment tool'. This involves filling in a questionnaire on the computer, which then calculates your risk of fracture over the next 10 years. To complete it, your healthcare professional will need details of your age, sex, height and weight, whether you have certain related conditions or are taking steroids, and how much you smoke and drink. Your healthcare professional should use one of two tools, called FRAX and QFracture.

If you are aged over 80 years, your healthcare professional should use caution to interpret your assessment, because the calculated risk over 10 years may be misleading and underestimate your risk of fracture over a shorter time period.

These tools are only suitable for people within a certain age range. If you are over the upper age limit (currently 90 years for FRAX and 85 years for QFracture) your healthcare professional should automatically consider you to be at high risk of fracture. If you are under the lower age limit, a bone scan may be considered as described below.

Bone scans

You may be offered a bone scan if the results from the assessment tool show that your risk is close to the level at which treatment might help, to confirm whether it should be offered.

If you are aged under 40 years and thought to be at particularly high risk of fracture, for example, if you have had several previous fragility fractures, or a spine, wrist or hip fracture, or if you are or have recently been taking high doses of steroid tablets or having high-dose steroid injections, your fracture risk should be assessed using a bone scan.

Bone scans (also known as 'DXA' or 'DEXA' scans) measure bone density and show how strong the bones are. They are often used to diagnose osteoporosis. However, a bone scan should not usually be carried out to assess fracture risk unless an assessment tool has already been used.

When should I have another fracture risk assessment?

Your healthcare professional may reassess your fracture risk if:

  • there is a change in the factors that affect your risk (for example, if you start taking medication that increases your risk or if you have a fragility fracture) or

  • your risk was near to the level at which treatment should be offered and it is more than 2 years since your last assessment.

Questions you might like to ask your doctor

  • Why have I been offered a fracture risk assessment?

  • Can I request a fracture risk assessment if I am worried about osteoporosis?

  • How accurate are the online tools and are there factors that might affect their accuracy?

  • If I am at high risk of fracture, how can I reduce the risk and what treatments are available?

  • Why haven't I been offered a bone scan?

  • Information Standard