At present, the majority of men and women at high risk of fracture are not diagnosed or treated [6] and several studies have suggested that the case-finding strategies endorsed in many countries perform less than well [7]. Several tools have been

developed to integrate risk factors such as age, low body weight, history of fractures and use of glucocorticoids into a single estimate of fracture risk for an individual. These tools are either aimed at identifying individuals with an increased Obeticholic Acid risk of fractures (with the option to include a BMD result in the risk scoring) or identifying individuals at increased risk of having low BMD. However, because the effect of BMD on fracture risk is in itself influenced by the presence of clinical risk factors, fracture risk tools have also been used to guide physicians in whether to refer patients to a BMD measurement or not [8]. Fracture Risk Assessment Tool (FRAX®) uses 10 clinical risk factors and can be used with or without bone mineral density (BMD) to predict the 10-year probability of hip fractures or major osteoporotic fractures in patients (clinical spine, forearm, hip or shoulder fracture) [9] and [10]. The recently updated National selleck screening library Osteoporosis Foundation (NOF)

guidelines recommend treatment of individuals with an increased risk of fracture based on the FRAX® [11]. This involved postmenopausal women and men aged 50 years and older with low bone mass (T-score between − 1.0 and − 2.5, osteopenia) at the femoral neck or spine and a 10-year hip fracture probability ≥ 3% or a 10-year major osteoporotic fracture probability ≥ 20% as calculated by the FRAX® tool [11]. FRAX® has been validated in 11 independent cohorts [9], and country specific adaptations

are available to a large number of countries, including Denmark [9]. Simpler approaches Selleckchem Sirolimus have also been suggested. Age is strongly associated with fracture risk [1] and the U.S. Preventive Services Task Force (USPSTF) recommends screening with DXA in all women aged 65 years and older and in women below 65 years with increased risk of fracture (whose 10-year fracture risk is equal to or greater than that of 65-year-old white women without additional risk factors; 9.3% based on FRAX® calculation); diagnosis and treatment are determined from DXA result [12]. NOF also recommends DXA testing in women above 65 years and women aged 50–65 years with high risk factor profile [11]. BMD has also a strong association with fracture risk where individuals with low BMD have progressively higher risk of fracture [13]. Several tools based on fewer clinical risk factors are available to predict low BMD. As discussed above, the justification for such tools is primarily to identify women who are more likely to have low BMD and then could undergo BMD measurement for a definitive assessment.