Targeting risk assessment
1.1 Consider assessment of fracture risk:
・ In all women aged 65 years and over and all men aged 75 years and over
・ in women aged under 65 years and men aged under 75 years in the presence of risk factors, for example:
- previous fragility fracture
- current use or frequent recent use of oral or systemic glucocorticoids
- history of falls
- family history of hip fracture
- other causes of secondary osteoporosis
- low body mass index (BMI) (less than 18.5 kg/m2)
- alcohol intake of more than 14 units per week for women and more than 21 units per week for men.
1.2 Do not routinely assess fracture risk in people aged under 50 years 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), because they are unlikely to be at high risk.
Methods of risk assessment
1.3 Estimate absolute risk when assessing risk of fracture (for example, the predicted risk of major osteoporotic or hip fracture over 10 years, expressed as a percentage).
1.4 Use either FRAX  (without a bone mineral density [BMD] value if a dual-energy X-ray absorptiometry [DXA] scan has not previously been undertaken) or QFracture, within their allowed age ranges, to estimate 10-year predicted absolute fracture risk when assessing risk of fracture. Above the upper age limits defined by the tools, consider people to be at high risk.
1.6 Do not routinely measure BMD to assess fracture risk without prior assessment using FRAX (without a BMD value) or QFracture.
1.7 Following risk assessment with FRAX (without a BMD value) or QFracture, consider measuring BMD with DXA in people whose fracture risk is in the region of an intervention threshold for a proposed treatment, and recalculate absolute risk using FRAX with the BMD value.
1.9 Measure BMD to assess fracture risk in people aged under 40 years who have a major risk factor, such as history of multiple fragility fracture, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer).
1.11 Take into account that risk assessment tools may underestimate fracture risk in certain circumstances, for example if a person:
・ has a history of multiple fractures
・ has had previous vertebral fracture(s)
・ has a high alcohol intake
・ is taking high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer)
・ has other causes of secondary osteoporosis.