Faculty Opinions recommendation of Development of a nomogram for individualizing hip fracture risk in men and women.

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Abstract
It is obvious that the prescription of treatment for osteoporosis should be based on absolute risk of fracture (rather than relative risk). However, practical ways of doing this, like the technique described in this observational study, are only just becoming available. The authors, using data from a 15-year community study in Dubbo, Australia, have examined the predictive value of many putative risk factors (recorded at entry into the study) for subsequent hip fracture. The strongest predictors were femoral bone mineral density (BMD) T-score, age, prior fracture and prior falls. They have incorporated these into easy-to-use nomograms that give numeric assessments of 5- and 10-year fracture risk. The findings need to be confirmed in prospective studies but are relevant to anyone treating osteoporosis. Understanding that low BMD alone in an otherwise fit 60-year-old is associated with a low 5- and 10-year fracture risk should make us more conservative about prescribing. This will also be a valuable tool for patients, who readily understand the concept of numbers needed-to-treat, and will help them play a bigger part in decisions concerning their health.

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