Primary fracture prevention
While approximately one in two women and one in five men over the age of 50 years will sustain a fragility fracture during their lifetime, the majority of older adults do not have a fracture history at any given time. In New Zealand, it is estimated that 200,000 individuals aged 50 years and over have a fracture history, while the other 1.6 million do not.
Using fracture risk calculators to assess high-risk groups affords a stepwise, risk-stratified approach to primary fracture prevention.
A stepwise, risk-stratified approach to primary fracture prevention is therefore essential to manage the burden on primary care and DXA services. High-risk groups, such as those taking medications linked to bone loss, individuals with conditions associated with osteoporosis, and frequent fallers, should be prioritised for fracture risk assessment.
The use of absolute fracture risk calculators such as FRAX® or the Garvan Fracture Risk Calculator enables primary care teams to assess fracture risk across their entire older population. A logical approach might involve assessing the highest-risk groups first, followed by sequentially younger age groups, as resources allow. Proactively, general practices can encourage patients to complete the consumer-friendly Know Your Bones™ online fracture risk self-assessment upon reaching age 50.
By following this stepwise strategy, primary care practices could systematically assess fracture risk in their entire 50+ population over 5 to 10 years, providing timely interventions where needed without overburdening the practice team or local DXA services.