This summary outlines risk factors and recommendations associated with fragility fractures, and includes a treatment pathway for postmenopausal women from risk factors to pharmacological treatment. For further information, refer to the full guideline.
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Table 1: Risk factors associated with fragility fracture which should prompt consideration of fracture-risk assessment
|Risk category||Causative factor|
|Abbreviations: BMI=body mass index; DMPA=depot medroxyprogesterone acetate; GnRH=gonadotropin-releasing hormone; PPI=proton pump inhibitor; RA=rheumatoid arthritis; SLE=systemic lupus erythematosus; TZD=thiazolidinedione|
|Modifiable risk factors||
Table 2: Recommendations associated with modifiable risk factors for fragility fractures
|Risk category||Affected group||Recommendation|
|Abbreviation: BMI=body mass index|
|Alcohol||People who consume more than 3.5 units per day of alcohol||Reduce alcohol intake to nationally recommended levels (<14 units per week)|
|Smoking||All smokers||Stop smoking|
|Weight||People with low BMI (<20 kg/m2)||Achieve and maintain a BMI level of 20–25 kg/m2|
|Coexisting diseases||People with conditions that predispose to osteoporosis (see Table 1)||Where possible treat coexisting disease|
|Drug treatments||People taking drugs that predispose to osteoporosis (see Table 1)||Where possible reduce or stop drug therapy|
Algorithm 1: Pathway from risk factors to pharmacological treatment selection in postmenopausal women over the age of 50
Want to learn more about this guideline?
Read the related Guidelines in Practice article, Osteoporosis: target treatment on the basis of fracture risk
Scottish Intercollegiate Guideline Network. Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN; 2015. (SIGN Guideline No. 142). Available at: www.sign.ac.uk/our-guidelines/management-of-osteoporosis-and-the-prevention-of-fragility-fractures
Published date: March 2015.
Last updated: January 2021.
Lead image: lordn/stock.adobe.com