Evaluation of Fracture Risk

  • Eugene V. McCloskeyEmail author


The World Health Organization (WHO) diagnostic criterion for osteoporosis, launched in 1994, was based on the bone mineral density (BMD) T-score (<−2.5) and is still used in many healthcare systems as a necessary requirement for reimbursement of osteoporosis therapies that reduce fracture risk. However, as implied by this chapter title, and indeed the definition of osteoporosis itself (see Chap.  2), there is more to the assessment of fracture risk than simply the identification of BMD-defined osteoporosis.


Osteoporosis Fracture risk Bone mineral density DXA FRAX Bone structure Bone mass QCT QUS 


  1. 1.
    [No authors listed]. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129.Google Scholar
  2. 2.
    Johnell O, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–94.CrossRefGoogle Scholar
  3. 3.
    Genant HK, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res. 1996;11(6):707–30.CrossRefGoogle Scholar
  4. 4.
    National Institute for Health and Care Excellence NICE Clinical Guideline 146. Osteoporosis: assessing the risk of fragility fracture. 2012. DOI:
  5. 5.
    Knapp KM. Quantitative ultrasound and bone health. Salud Publica Mex. 2009;51(Suppl 1):S18–24.PubMedGoogle Scholar
  6. 6.
    International Society for Clinical Densitometry, Official Positions 2015 ISCD Combined. 2015.Google Scholar
  7. 7.
    Silva BC, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014;29(3):518–30.CrossRefGoogle Scholar
  8. 8.
    Boutroy S, et al. In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab. 2005;90(12):6508–15.CrossRefGoogle Scholar
  9. 9.
    Vasikaran S, et al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med. 2011;49(8):1271–4.CrossRefGoogle Scholar
  10. 10.
    Kanis JA. on behalf of the WHO Scientific Group, Assessment of osteoporosis at the primary health-care level. Technical Report. 2008, WHO Collaborating Centre, University of Sheffield, UK: Sheffield.Google Scholar
  11. 11.
    Kanis JA, et al. SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos. 2013;8(1–2):144.CrossRefGoogle Scholar
  12. 12.
    Kanis JA, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57.CrossRefGoogle Scholar
  13. 13.
    Compston J, et al. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. 2013;75(4):392–6.CrossRefGoogle Scholar
  14. 14.
    Dawson-Hughes B, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19(4):449–58.CrossRefGoogle Scholar
  15. 15.
    Shepstone L, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391(10122):741–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Center for Metabolic Bone Diseases, University of Sheffield Medical SchoolSheffieldUK

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