Who to treat due to high risk of bone fracture – the logic of the World Health Organization 2007 standpoint

The multiple causes of osteoporosis and diversity of pathological changes in bones make it impossible to give
a diagnosis based on uniform criteria. A 10-year evaluation of absolute individual risk of fracture (AR-10) based on independent and self-sufficient factors of fracture risk is a primary duty. These factors are: advanced age, previous fracture, hip fracture in parents, low BMI, low BMD, therapy with glucocorticosteroids, rheumatoid arthritis, smoking and alcohol abuse. AR-10 is calculated by multiplying population risk (PR-10) by relative risk (RR)
of independent and self-sufficient factors of fracture (an individual’s AR-10 = PR-10 × his/her RR). According to Johnell AR-10 below 8% requires no intervention, above 14% justifies treatment regardless of BMD level, between 8% and 14% is a signal to measure one’s BMD to assess the risk more precisely. The aim of treatment is to reduce the risk of fracture. With BMD T-score –2.0 only some medicines are effective; therefore the only method of reducing the risk of fracture is to eliminate the fracture risks we can control.