Risk assessment of fragility fractures: summary of NICE guidance.

This is one of a series of BMJ summaries of new guidelines based on the best available evidence; they highlight important recommendations for clinical practice, especially where uncertainty or controversy exists. Further information about the guidance, a list of members of the guideline development group, and the supporting evidence statements are in the full version on bmj.com. Who needs risk assessment? • Consider assessing fracture risk in: – All women aged ≥65 years and men aged ≥75. – 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/m) (<18.5). • People aged <50 years are unlikely to be at high risk of fracture, so do not routinely assess their fracture risk with a risk assessment tool unless they have major risk factors (for example, current or frequent recent use of oral or systemic glucocorticoids, untreated premature menopause, or previous fragility fracture). • In people aged <40 years, consider measuring bone mineral density to assess their fracture risk only if they have a major risk factor such as history of multiple fragility fractures, major osteoporotic fracture, or current or recent use of high dose oral or high dose systemic glucocorticoids (>7.5 mg prednisolone or equivalent daily for three months or longer). • Consider to be at high risk people over the age limit of the risk assessment tools (90 years for FRAX and 85 years for QFracture; box 2).