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Read this summary and then ‘Test and reflect’ using our multiple-choice questions.
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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
Risk categoryAffected groupRecommendation
Alcohol People who consume more than 3.5 units 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



full guideline available from…


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