1987 was a key year for osteoporosis:  in 1987, large cohort studies examining fracture risk were begun and the first densitometers became available.  Since that time, we have learned an enormous amount about assessing fracture risk.  These results will be discussed in this talk.

On the demographic side, we can quantify the effect of age, gender, race, weight on risk for vertebral, hip and other fractures.  We have learned about the importance of other clinical risk factors that can be assessed from patient reports:  personal and family fracture history, smoking, excessive alcohol use, glucocorticoid use etc.  

On the imaging side, DXA BMD has been shown to be a remarkably strong predictor of fracture risk, particularly for hip and vertebral fractures.  For hip fractures, the relative risk per one SD decrease is 2.5 to 3, much stronger than the relationship of lipids or blood pressure to heart disease or stroke.  We now have remarkable data that shows that a single BMD measured in 1987 can predict hip and non-vertebral fracture for at least 25 years. 

Taking a page from our cardiology colleagues, we have put clinical risk factors together with imaging into multivariable risk scores which can better distinguish fracture risk.  FRAX, Garvin, SOFSurf—take your pick:  they combine DXA with clinical factors and are incorporated into treatment guidelines internationally.

These huge successes in risk assessment, in parallel with treatment advances, mean that we can successfully and efficiently screen and treat.  This talk will include a comparison to cardiovascular screening/treatment which dramatically proves the value of risk assessment in osteoporosis.