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Fracture Risk

Bone density is only one part of the story

We have long known that there are factors other than bone density that affect a person’s risk of having a fracture. Age is the most important factor; at the same level of bone density. Older people have much higher fracture risk. If someone has had a fracture, then the risk of having another is nearly doubled. A number of medical problems can contribute to fracture risk: being very thin, smoking, drinking heavily, having rheumatoid arthritis, and taking cortisone-like drugs all may play a role. This interplay of clinical risk factors explains why more than half of patients who have osteoporotic-type fractures (due to relatively minor injury) do not have very low bone density values in the osteoporosis range.

Measuring your risk for having a fracture

Researchers working with the World Health Organization developed a method to measure the likelihood of someone fracturing in the future. Using a combination of clinical risk factors, we can now estimate the probability that a person will have a fracture of the spine, hip, shoulder or wrist over the next 10 years.1

The purpose of treating patients is to reduce the chance of having a new fracture

The drugs that we now have are very effective in decreasing the likelihood of having new fractures; they reduce risk by at least one-third. However, because these medicines have costs, inconveniences, and possible (though infrequent) side effects, it is important for doctors to identify the patients who will most likely benefit from treatment. Not only is it a better use of our resources to treat people at higher risk, but, surprisingly, patients at high risk of fracture benefit much more from treatment than those at low risk. Using a fracture risk tool, doctors will move away from treating just the T-score and will be able to target therapy toward patients with moderate and high risk who will receive the most benefit from the drugs.2

Prevention is always important — despite your risk

You must get adequate calcium and vitamin D, exercise regularly, quit smoking, and think about how to reduce falls. And if your doctor prescribes bone-strengthening medications, take it regularly and the right way.


(1) Kanis, JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet, 2002; 359:1929-36.

(2) McClung, MR Do current management strategies and guidelines adequately address fracture risk? Bone. 2006; 38: S13- S17.


Posted: 12/5/2016; Revised: 01/13/20. 
As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician

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Calculate Your Risk

The American Bone Health Fracture Risk Calculator™ estimates fracture risk for women and men over age 45.

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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.