Screening
The FRAX tool, developed by the World Health Organization (WHO), is widely used to identify decreased bone mineral density (BMD) in people with risk factors for osteoporosis, therefore suggesting a greater risk of osteoporotic fracture. The FRAX algorithms give the 10-year probability of fracture. FRAX®: WHO fracture risk assessment tool Opens in new window Q-fracture is also used in some regions, e.g., in the UK (as recommended by NICE), to estimate 10-year predicted absolute fracture risk.[48] ClinRisk: QFracture®-2016 risk calculator Opens in new window
The US Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women aged 65 years or older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.[49] The USPSTF does not recommend routine osteoporosis screening in men since current evidence is insufficient to assess the balance of benefits and harms of screening in this population.[49] NICE recommends to assess fracture risk in all women aged 65 years and over and all men aged 75 years and over, and 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), smoking, and alcohol intake of more than 14 units per week for men and women.[48] NICE recommend to 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, people should be considered to be at high risk.[48] NICE suggests that women aged 75 years or older may not need a bone densitometry scan to diagnose their osteoporosis if it is thought to be unfeasible or clinically inappropriate by the supervising physician.[66] See Osteoporosis.
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