Imminent fracture risk: contributing mechanisms, risk assessment and implications for treatment

Identifying imminent fracture risk is a critical opportunity to manage osteoporosis. This term refers to the sharply elevated probability of sustaining a subsequent fragility fracture within a determined period-typically 12 to 24 months-after an initial sentinel fracture. While a prior fracture is widely recognised as a primary predictor of future events, epidemiological data show that this risk is not uniform; rather, it peaks significantly within the first 3 to 6 months after injury. This review discusses a significant clinical gap: traditional assessment tools often focus on long-term, 10-year risk projections, which may delay treatment during this high-vulnerability period. Recognising imminent risk highlights clinical urgency, indicating the need for early use of therapeutic interventions to rapidly reduce the risk of further fractures. Identifying patients at imminent risk offers an opportunity for secondary prevention, promoting immediate pharmacological action to interrupt the 'fracture cascade' and enhance long-term skeletal health.