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Practice Guidelines

Risk assessment of fragility fractures: summary of NICE guidance

BMJ 2012; 345 doi: (Published 08 August 2012) Cite this as: BMJ 2012;345:e3698
  1. Silvia Rabar, senior project manager and research fellow1,
  2. Rosa Lau, research fellow1,
  3. Norma O’Flynn, clinical director1,
  4. Lilian Li, health economist1,
  5. Peter Barry, consultant paediatric intensivist and honorary senior lecturer 2
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Department of Child Health, Leicester Royal Infirmary, Leicester LE2 7LX, UK
  1. Correspondence to: S Rabar silvia.rabar{at}

Osteoporosis is characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture, particularly fractures that result from mechanical forces that would not ordinarily result in fracture, known as fragility fractures. The prevalence of osteoporosis rises markedly with age, and in women this rises from 2% at 50 years to more than 25% at 80 years. Risk of fracture is also increased by factors such as lifestyle, drug treatments, family history, and other conditions that cause secondary osteoporosis. Several validated risk assessment tools are available to predict fracture risk. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on risk assessment of fragility fractures.1


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Who needs risk assessment?

  • Consider assessing fracture risk in:

    • -All women aged ≥65 years and men aged ≥75. [Based on moderate/low quality observational studies in a large number of patients]

    • -Women between 50 and 65 years and men between 50 and 75 years if they have risk factors—for example, previous fragility fracture; history of falls; current or frequent recent use of oral or systemic glucocorticoids; other causes of secondary osteoporosis (box 1); smoking; alcohol intake >14 units a week for women and >21 units a week for men; family history of hip fracture; low body mass index (kg/m2) (<18.5). [Based on moderate or low quality observational studies in a large number of patients and on the experience and opinion of the Guideline Development Group (GDG) …

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