The Journal of Bone and Joint Surgery (American). 2010;92:743-753.
doi:10.2106/JBJS.I.00919
© 2010 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

The Assessment of Fracture Risk

Aasis Unnanuntana, MD1, Brian P. Gladnick, BA2, Eve Donnelly, PhD3 and Joseph M. Lane, MD1

1 Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for A. Unnanuntana: unnanuntanaa{at}hss.edu
2 Weill Cornell Medical College, Cornell University, 1300 York Avenue, New York, NY 10021
3 Mineralized Tissues Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health (F32 AR561482) and the Cohn Foundation. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Eli Lilly & Company, P&G, Sanofi-aventis, and Novartis).

Bone mineral density is considered to be the standard measure for the diagnosis of osteoporosis and the assessment of fracture risk. The majority of fragility fractures occur in patients with bone mineral density in the osteopenic range.

The Fracture Risk Assessment Tool (FRAX) can be used as an assessment modality for the prediction of fractures on the basis of clinical risk factors, with or without the use of femoral neck bone mineral density. Treatment of osteoporosis should be considered for patients with low bone mineral density (a T-score of between –1.0 and –2.5) as well as a ten-year risk of hip fracture of ≥3% or a ten-year risk of a major osteoporosis-related fracture of ≥20% as assessed with the FRAX.

Biochemical bone markers are useful for monitoring the efficacy of antiresorptive or anabolic therapy and may aid in identifying patients who have a high risk of fracture.

An approach combining the assessment of bone mineral density, clinical risk factors for fracture with use of the FRAX, and bone turnover markers will improve the prediction of fracture risk and enhance the evaluation of patients with osteoporosis.


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