Future Developments: Risk Assessment

  • Philip D. Ross
  • Piet Geusens


  • Figure 26.1 illustrates how the risk assessment would proceed using the methods described in this chapter.

  • Patients with a hip or vertebral fracture almost certainly have a high risk of subsequent fractures and can be treated even if BMD measurements are not available.

  • In patients without an obvious history of fracture , the prevalent vertebral fracture index (PVFI) can help determine when to obtain spine radiographs to look for undiagnosed vertebral fractures.

  • In patients without fractures, the Osteoporosis Self-assessment Tool (OST), the Osteoporosis Self-assessment Tool for Asians (OSTA), and other tools such as the Simple Calculated Osteoporosis Risk Estimation (SCORE) can help determine whether BMD should be measured.

  • After measuring BMD, fracture probability can be calculated to decide whether treatment is warranted.

  • If BMD is not available, consider treatment if body weight is low and the patient is over 65 years of age, or if the patient is classified as high-risk based on one of the other non-BMD risk indices.

  • Patients receiving treatment should have regular follow-up visits to encourage adherence to treatment.

  • Other patients should be re-evaluated at least every two to five years to see whether their fracture status or risk status has changed.

The focus of this chapter is on assessing the risk of osteoporosis and fractures related to skeletal fragility. Thus, the emphasis is on identifying patients with low BMD and those who have already had a fracture and then using this information to estimate the risk of future fractures. An algorithm is provided in Figure 26.1 to assist the reader in deciding when to use each of the tools described below for evaluating patients. Although falls are an important factor in increasing the risk of fractures among patients with osteoporosis, the etiology and interventions to prevent falls are generally independent of skeletal fragility and therefore receive less attention here.


Vertebral Fracture Fracture Risk Fracture Probability Vertebral Deformity Fracture Intervention Trial 
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Copyright information

© Springer-Verlag London 2004

Authors and Affiliations

  • Philip D. Ross
  • Piet Geusens

There are no affiliations available

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