SIGN osteoporosis guideline

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Risk factors

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

Risk category	Causative factor
Non-modifiable 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 category	Affected group	Recommendation
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

full guideline available from…

www.sign.ac.uk/sign-142-management-of-osteoporosis-and-the-prevention-of-fragility-fractures.html

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