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NICE publishes fragility fracture risk guidance

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Final guidance has been published for nurses to use in the assessment of fragility fracture risk in adults and to support them in identifying patients who will benefit from preventative treatment.

The National Institute for Health and Clinical Excellence (NICE) guidance has been put together to help the 300,000 people a year who present with fragility fractures - often as a result of osteoporosis - most commonly to the spinal vertebrae, hip and waist.

The final guidance in the short clinical recommendations states:

  • Estimate absolute risk when assessing risk of fracture (for example, the predicted risk of major osteoporotic or hip fracture over 10 years, expressed as a percentage)
  • Use either FRAX (without a bone mineral density [BMD] measurement) or QFracture, within their allowed age ranges, to estimate 10-year predicted absolute fracture risk when assessing risk of fracture. Above the upper age limits defined by the tools, consider people to be at high risk
  • Interpret the estimated absolute risk of fracture in people aged over 80 years with caution, because predicted 10-year fracture risk may underestimate their short-term fracture risk
  • Do not routinely measure BMD to assess fracture risk without prior assessment using FRAX (without a BMD value) or QFracture
  • Measure BMD to assess fracture risk in people aged under 40 years who have a major risk factor, such as history of multiple fragility fractures, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for three months or longer)

Professor Mark Baker, director of the Centre for Clinical Practice, said: “The guideline will help provide clarity for health professionals on which risk assessment tools to use to predict the likelihood of fragility fracture in adults over a period of time. This will assist in overcoming the difficulties in identifying who might benefit from treatment to help prevent fractures linked to bone tissue deterioration. We hope that this new guideline will help in supporting the care of people at risk of fragility fractures.”

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