Risk factors for minimal-trauma fracture

Falls and low bone mineral density (BMD) are significant risk factors for minimal-trauma fracture. Most other risk factors for minimal-trauma fracture contribute to falls risk or BMD loss. See Risk factors for minimal-trauma fracture for a list of risk factors for minimal-trauma fracture.

Women have a lower peak BMD than men and their BMD decreases in association with menopause, so they have a higher lifetime risk of osteoporosis and fracture than men.

Age increases the incidence of minimal-trauma fractures at all sites; the incidence of proximal femoral fractures increasing exponentially in elderly people.

Absolute fracture risk can be calculated using an online calculator (eg Fracture Risk Assessment Tool [FRAX], Garvan Institute Fracture Risk Calculator). The role of absolute fracture risk calculators in practice is evolving; they are particularly useful to identify patients at low fracture risk who do not require drug therapy.

Table 1. Risk factors for minimal-trauma fracture
Nonmodifiable factors
previous minimal-trauma fracture female sex postmenopause early menopause late menarche ageing family history of osteoporosis
Modifiable factors
Falls and factors that increase the risk of falls, including: balance disorder visual impairment muscle weakness and sarcopenia sedating drugs antihypertensive drugs
Drugs that affect bone homeostasis or density, including: glucocorticoids androgen deprivation therapy for prostatic cancer aromatase inhibitors for breast cancer excessive thyroid hormone replacement long-term heparin selective serotonin reuptake inhibitors antiepileptic drugs, particularly hepatic enzyme inducers (modest effect) thiazolidinediones (modest effect) proton pump inhibitors (modest effect)
Lifestyle and nutrition factors, including: smoking hazardous alcohol consumption physical inactivity immobilisation low calcium intake vitamin D deficiency low protein intake
Disorders that affect bone homeostasis or density, including: endocrine disorders: sex hormone deficiency Cushing syndrome hyperthyroidism hyperparathyroidism diabetes mellitus malabsorption syndromes: coeliac disease gastric or bowel resection bariatric surgery chronic disorders (eg liver, kidney or cardiopulmonary diseases) low body weight and weight loss, including anorexia nervosa rheumatoid arthritis and other connective tissue diseases haematological disorders (eg multiple myeloma, myeloproliferative disorders)