Common Questions
What risk factors are important in treatment decisions?
The following risk factors are considered especially important in making treatment decisions (1). While many others have been identified, these risk factors are felt to be most useful in the clinical setting and are independent of BMD.
- Personal history of fracture after age 40
- Family history of fracture in first degree relative (particularly prior to age 80)
- Current cigarette smoking
- Low body weight, < 127 lbs., regardless of height
The use of risk factor information in treatment decisions of osteoporosis is analogous to drug treatment of cholesterol. The drug treatment initiation level is lower in an individual who has known coronary artery disease than in a patient without risk factors. Similarly, treatment of postmenopausal women is dependent on both the bone mineral density result and the presence of known fragility fractures or other risk factors.
| Risk Factor | Relative Risk if Factor Present* (known bone Mineral density and age) |
|---|---|
| Family history | 1.30 |
| Smoker | 1.50 |
| Prior fracture | 1.40 |
| Thin | 1.20 |
*These are relative risks if the patient has the factor versus does not have the factor, adjusted for age and bone mineral density.
Table adapted from:
Heaney RP. Bone mass, bone fragility, and the decision to treat. JAMA. 1998 Dec 23- 30;280(24):2119-20.
- World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Report of a WHO Study Group.. World Health Organization, Geneva Switzerland 1994; Technical.