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Management of osteoporosis and the prevention of fragility fractures

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Risk factors

Risk factors associated with fragility fracture which should prompt consideration of fracture-risk assessment

Risk categoryCausative factor
risk factors
  • Previous fracture
  • Parental history of osteoporosis
  • History of early menopause (below age of 45)
Modifiable risk factors
  • Low BMI (<20 kg/m2)
  • Smoking
  • Low bone mineral density
  • Alcohol intake
Coexisting diseases
  • Diabetes
  • Inflammatory rheumatic diseases (RA or SLE)
  • Inflammatory bowel disease and malabsorption
  • Institutionalised patients with epilepsy
  • Primary hyperparathyroidism and endocrine diseases
  • Chronic liver disease
  • Neurological diseases (including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke)
  • Moderate to severe chronic kidney disease
  • Asthma
Drug therapy
  • Long-term antidepressants
  • Antiepileptics
  • Aromatase inhibitors
  • Long-term DMPA
  • GnRH agonists (in men with prostate cancer)
  • PPIs
  • Oral glucocorticoids
  • TZDs
Recommendations associated with modifiable risk factors for fragility fractures
RiskcategoryAffected groupRecommendation
Alcohol People who consume more than 3.5units per day of alcohol Reduce alcohol intake to nationally recommended levels (<21 units per week in men, <14 units per week in women)
Smoking All smokers Stop smoking
Weight People with low BMI (<20kg/m2) Achieve and maintain a BMI level of 20–25 kg/m2

Pathway from risk factors to pharmacological treatment selection in postmenopausal women

Pathway from risk factors to pharmacological treatment selection in postmenopausal women



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full guideline available from…


Scottish Intercollegiate Guideline Network. Management of osteoporosis and theprevention of fragility fractures. Edinburgh: SIGN; 2015. (SIGN Guideline No. 142).
First included: August 2015.