Multifaceted approach best for assessing osteoporotic fracture risk: NPS

22 June 2011

NPS has released a new education program for health professionals - Reducing osteoporotic fracture risk and building healthy bones – encouraging use of a multifaceted approach to help identify those most at risk of osteoporotic fractures and target interventions accordingly.

NPS clinical adviser Dr Danielle Stowasser says osteoporosis poses a significant burden on society in terms of morbidity, mortality and health care costs.

“Over 2.2 million Australians are affected by osteoporosis, and, with an ageing population, the rate of osteoporotic fractures is increasing. In recent years, there has been a shift towards using multifactorial risk assessments to help health professionals identify people who are most at risk of osteoporotic fracture and better target interventions to prevent osteoporosis and fracture. This new NPS program will help health professionals assess people using more than just bone mineral density measurements and implement interventions to help reduce their fracture risk.”

Two internet-based fracture risk calculators are freely available. They estimate individual fracture risk for both men and women, with or without a previous history of fracture.

  1. The WHO fracture risk assessment tool,FRAX®, accessible at, estimates fracture risk over the next 10 years and requires a bone mineral density (BMD) measurement.
  2. The Garvan Institute Fracture Risk Calculator, accessible at, estimates fracture risk over the next 5 and 10 years, with or without a BMD measurement.

“Part of reducing fracture risk also involves measures for preventing falls. Removing hazards in the home, such as loose rugs and poor lighting can greatly reduce the risk of a fall for everyone, not just people with osteoporosis.”

Health professionals are encouraged to think broadly about fracture risk and to review other medical conditions, medicines or lifestyle factors which may contribute to an increased fracture risk.

“Certain medicines can weaken bones, while others have side effects such as dizziness or drowsiness, that may increase the risk of falls. Health professionals should review use of such medicines and, where possible, stop or decrease the dose. Encouraging people to make lifestyle changes, like quitting smoking and/or reducing alcohol intake, can also significantly improve health outcomes,” Dr Stowasser said.

Other lifestyle factors for maintaining good bone health for people with osteoporosis include:

  • Obtaining adequate calcium. Three serves of dairy per day is enough calcium for most adults. Calcium-fortified or calcium-containing foods such as tofu and almonds are suitable for those who avoid dairy products or are lactose intolerant. Where adequate dietary intake is not achievable, a calcium supplement may be needed.
  • Ensuring sufficient vitamin D levels. Vitamin D deficiency is a risk factor for osteoporosis and adequate vitamin D is important for people taking osteoporosis medicines. A vitamin D supplement may be required if levels are inadequate. For more information on vitamin D visit
  • Getting regular exercise. Encourage people at risk of fracture to exercise by explaining its goals: muscle strength and endurance, balance and stability, mobility and quality of life, and falls prevention. Be aware that certain exercises are unsuitable for people with osteoporosis because they can cause fractures. People need adequate calcium and vitamin D status to fully benefit from exercise.

“A minimal trauma fracture of any kind in an older person should trigger a fracture risk assessment and for those patients presenting with an osteoporotic fracture, the use of an anti-osteoporotic drug can help reduce the risk of future fractures,” Dr Stowasser said.

For more information and access to other NPS resources and activities on this topic visit


Independent, evidence-based and not-for-profit, NPS enables better decisions about medicines and medical tests.We are funded by the Australian Government Department of Health and Ageing.