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According to the World Health Organization (WHO), osteoporosis accounts for nearly 9 million fractures annually worldwide. Although many new treatments have been developed to treat bone loss in order to prevent fractures, up to this point it has been nearly impossible for doctors to predict with any degree of accuracy which patients with osteoporosis would benefit the most from these treatments. Identifying patients who are at high risk of a bone fracture would enable doctors to initiate treatments to strenghten bone and, therefore, reduce the risk of fractures.

Historically, doctors have used bone mineral density (BMD) measurements as the single most important criteria for diagnosing osteoporosis. Based on the 1994 WHO criteria for the diagnosis of osteoporosis, women older than 50 years in age with a BMD value at least 2.5 standard deviations (SD) below the average for a healthy young woman met the criteria for the diagnosis of osteoporosis and required treatment.

Although it is well-established that people with osteoporosis are at higher risk for developing fractures, more recent data obtained by the WHO from large cohort studies conducted around the world strongly suggests that BMD is not the only criteria that can be used to predict an individual's long-term risk for developing a fragility fracture. Based on these studies, the WHO identified 10 risk factors (independent of BMD) that, taken together, are a highly sensitive tool for calculating a person's long-term (10-year) fracture risk. The 10 BMD-independent risk factors for predicting the 10-year fracture risk include:

• A person's age
• A person's sex
• Previous history of fractures
• Presence of rheumatoid arthritis
• Use of glucocorticoid steroids
• Family history of hip fracture
• Currently a smoker
• Alcohol consumption (3 or more drinks per day)
• Low body mass index
• Secondary osteoporosis (bone loss caused by another underlying condition)

Based on an algorithm of the above 10 validated risk factors for fractures, the WHO developed a Web-based interactive tool to enable doctors to input a patient's individual risk factors, along with the BMD score (if available), and instantly obtain a calculation of the estimated 10-year fracture risk for the patient. The WHO Fracture Risk Assessment Tool (FRAX) is available at http://www.shef.ac.uk/frax. It is anticipated that in the near future some BMD machines will incorporate the WHO algorithm for estimating the fracture risk into their computers and will provide, in addition to the BMD score, information about an individual's 10-year fracture risk.

In 2008, the National Osteoporosis Foundation updated its guidelines for doctors regarding the management of patients with osteoporosis. The new guidelines recommend that, prior to initiating treatment, doctors should estimate an individual patient's 10-year probability of hip and/or other major osteoporosis-related fractures using the WHO algorithm of the 10 validated risk factors for fractures. Once the fracture risk has been determined, doctors should consider instituting FDA-approved medical therapies for any patient who falls into any of the following categories: