Assessing fracture risk in adults

  • Date: 13 August 2012

NICE has published guidance to help clinicians assess patients who might be at risk of a fragility fracture and identify those likely to benefit from preventative treatment.

Each year in the UK over 300,000 people are seen in hospital because of fragility fractures, with the most common sites for these fractures being the spinal vertebrae, hip and wrist. Such fractures are often linked to osteoporosis, with a lower than normal bone density which can lead to fracturing in falls from standing height or less.

Fragility fractures are linked to decreased life expectancy: about 10% of people with a hip fracture die within one month, although most of the deaths are due to associated conditions and not to the fracture itself.

Among recommendations in the short clinical guideline is the need to estimate absolute risk when assessing risk of fracture (i.e. predicted risk of major osteoporotic fracture over 10 years, expressed as a percentage) and to interpret the estimated absolute risk of fracture in people aged over 80 years with caution, because predicted 10-year fracture risk may underestimate their short-term fracture risk.

Clinicians should also measure BMD to assess fracture risk in people aged under 40 years who 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.

Professor Mark Baker, Director of the Centre for Clinical Practice, commented: "Fragility fractures can cause substantial pain and severe disability, so we‘re pleased to be publishing this new short clinical guideline to help in assessing the risk of fragility fractures in adults. The guideline will help provide clarity for health professionals on which risk assessment tools to use to predict the likelihood of fragility fracture in adults over a period of time. This will assist in overcoming the difficulties in identifying who might benefit from treatment to help prevent fractures linked to bone tissue deterioration. We hope that this new guideline will help in supporting the care of people at risk of fragility fractures."

Osteoporosis: assessing the risk of fragility fracture is available at


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