Will absolute fracture risk prediction facilitate treatment of osteoporosis?

Development of valid risk prediction tools for osteoporosis could substantially improve patient care. These tools have the potential to identify individuals at increased fracture risk and specifically direct interventions towards them rather than low-risk individuals. In this Practice Point commentary, I discuss a study by Hans et al. that adds to our current understanding of fracture risk prediction. This large, prospective study aimed to develop a 10-year hip fracture risk prediction tool that combined quantitative ultrasound of the heel bone with clinical risk factors. The authors found that combined use of these parameters was highly predictive of future fracture risk in a cohort of almost 13,000 elderly, white, European women. Significant clinical risk factors included BMI, previous fracture, history of recent fall, current smoking, failed chair test, and diabetes mellitus; age was also found to be a significant risk factor. Before embracing such tools, however, we must acknowledge some important unknowns about their utility.