Fracture risk assessment

Some people are more likely to develop osteoporosis and have fractures. Factors that increase your chances of getting osteoporosis or breaking a bone are called risk factors. If you have 1 or more of the following risk factors, you should have a fracture risk assessment.

Note: While studies show that people of Polynesian descent, including Māori, tend to have stronger bones (higher bone mineral density) and a lower risk of fractures, individual risk can still vary. A fracture risk assessment may still be recommended if other risk factors are present.

The following are risk factors for osteoporosis and fractures that are used to guide who should be assessed.

Family history and fracture risk

• If you have a parent who has had a hip fracture.
• If you've fallen in the past, feel unsteady on your feet, or have less muscle strength.
• If you take medicines that affect balance and increase the risk of falls by causing dizziness or drowsiness. See medicines and falls risk.

Older age

• Women over 60 years of age.
• Men 75 years of age and over.

Lifestyle factors

• Smoking.
• Low body weight (body mass index less than 20 kg/m2).
• Low physical activity or are immobile.
• Drinking more than 2 standard alcoholic drinks daily.
• Not getting enough protein in your diet.
• Severe vitamin D deficiency.

Medical conditions

Some medical conditions can increase your risk of osteoporosis and fractures. These include:

• Menopause, including early menopause (eg, caused by surgery or treatment).
• Missing periods for more than 6 months in women under 45 years of age, not due to hormone treatment or birth control.
• Diabetes (type 1 and type 2).
• Hormone-related conditions such as Cushing syndrome, hypogonadism, hyperparathyroidism and untreated hyperthyroidism.
• Digestive conditions that affect nutrient absorption such as coeliac disease or inflammatory bowel disease.
• Eating disorders.
• Blood-related conditions such as organ or bone marrow transplants and myeloma.
• HIV.
• Chronic liver disease or moderate to severe kidney disease
• COPD.
• Spinal cord injuries.
• Rheumatoid arthritis.
• Some cancers and their treatments, especially breast cancer, prostate cancer, and blood cancers.

Medicines

Some medicines can reduce bone strength by interfering with bone formation, calcium absorption, or hormone levels. This increases the risk of osteoporosis and fractures over time. These include:

• Ongoing steroid use, such as prednisone 5 mg/day for more than 3 months.
• Medicines that lower testosterone levels such as goserelin or leuprorelin.
• Aromatase inhibitors such as anastrozole, exemestane and letrozole.
• Some medicines to treat cancer (chemotherapy).
• Prolonged proton pump inhibitors (PPIs) such as omeprazole, lansoprazole and pantoprazole.
• Methotrexate.
• Pioglitazone.

In Aotearoa New Zealand, the FRAX and Garvan tools are the most commonly used tools for estimating fracture risk. Because they include different risk factors, they may produce different estimates for the same person.

If the fracture risk is clearly high or clearly low, FRAX and Garvan generally give similar results. However, if the risk is borderline, it can be helpful to use both tools and base decisions on the higher risk estimate.

FRAX tool

• It estimates your 10-year risk of hip fractures and other major fractures such as your spine, arm or shoulder.
• It includes ethnicity, smoking, alcohol use, and steroid medication use, which the Garvan tool doesn't include.
• This tool is used internationally. In Aotearoa New Zealand, the FRAX NZ version uses local population data. However, the United Kingdom model is recommended for people of European descent.

Garvan Fracture Risk Calculator

• It estimates 5- and 10-year risk of hip fracture or any fragility fracture.
• It takes into account how many fragility fractures someone has had before and how often they have fallen in the past year, which FRAX doesn't.
• This tool was developed in Australia and validated mainly in Australian populations.
• It may be preferred for people with frequent falls or in very old adults.

Your healthcare provider may suggest a bone density scan (called DEXA scan) to measure your bone strength. The result can be added to your FRAX or GARVAN assessment to give a more precise risk estimate. Learn more about DEXA scans.

The results will indicate a low, moderate or high fracture risk. The fracture risk varies depending on the type or location of the fracture. If you've already had a fracture from a minor injury, you're automatically considered to be at high risk.

Not all fractures can be prevented, but you can strengthen your bones and reduce the risk of osteoporosis and fractures through medicines and healthy lifestyle choices. There are some medicines that can lower the risk of future broken bones by 30 to 70%, depending on the type of medicine and where the fracture might happen.

Lifestyle changes

• Eat a balanced diet rich in calcium.
• Keep alcohol to safe limits, less than 2 drinks per day and at least 2 alcohol-free days per week.
• Stop smoking.
• Maintain a healthy weight (aim for a BMI of 20 or higher).
• Get safe sun exposure or take vitamin D supplements if needed. Read more about vitamin D.
• Take steps to prevent falls, such as checking your vision, reviewing your medicines, and keeping walkways clear.

Read more tips to keep your bones healthy.

Exercise – especially weight-bearing exercise

Regular exercise, which is essential for general wellbeing, helps prevent and treat osteoporosis. Bones become stronger when they're active, just like muscles.

The best exercises to strengthen your bones are ones that work your muscles against gravity, and where you bear your own weight. These include exercises such as running, dancing, tennis, skipping, hopping and walking. Resistance training such as lifting weights or using gym equipment helps to strengthen your upper body, and keep bones healthy.

Medicines to strengthen bones

Medicines used to strengthen bones work mainly by slowing or stopping bone loss or rebuilding bone. Read more about osteoporosis medicines.