Risk Factors

• Sex:
  

  Please note, ‘sex’ refers to sex assigned at birth, as opposed to a patient’s true gender. As healthcare and health research typically only recognizes female and male categories for birth sex, these are the options we have included. However, the Task Force recommends clinicians should offer care that affirms a patient’s gender and gender fluidity.

• Previous (fragility) fracture:
  

  A bone breakage in adult life occurring spontaneously, or from an incident that would not cause a bone to break in a healthy adult. A special situation pertains to a prior history of vertebral fracture. A fracture detected as a radiographic observation alone (a morphometric vertebral fracture) counts as a previous fracture. A prior clinical (i.e. symptomatic) vertebral fracture or a hip fracture is an especially strong risk factor. The probability of fracture computed may therefore be underestimated. Fracture probability is also underestimated with multiple fractures.

• Parent Fractured Hip:
  

  History of hip fracture in the patient's mother or father.

• Glucocorticoid:
  

  Enter yes if the patient is currently taking or has previously taken oral glucocorticoids for more than 3 months at a dose of prednisolone of 5mg daily or more (or equivalent doses of other glucocorticoids). This risk factor appears to have a dose-dependent effect, i.e. the higher the exposure, the greater the risk. This is not taken into account and the computations assume average exposure. Clinical judgment should be used for low or high exposures.

• Rheumatoid arthritis:
  

  Patient has a confirmed diagnosis of rheumatoid arthritis (RA). RA is a risk factor for fracture. However, osteoarthritis is, if anything, protective. For this reason, reliance should not be placed on a patient's report of 'arthritis' unless there is clinical or laboratory evidence to support the diagnosis.

• Secondary Osteoporosis:
  

  Patient has a disorder strongly associated with osteoporosis. These include type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption and chronic liver disease

• Alcohol:
  

  For this calculation, a unit of alcohol is equivalent to 285ml of beer (equivalent to 0.8 Canadian unit), a 30ml measure of spirits (equivalent to 0.7 Canadian unit), or a 120ml of wine (equivalent 0.8 Canadian unit). This risk factor appears to have a dose-dependent effect, i.e. the higher the exposure, the greater the risk. This is not taken into account and the computations assume average exposure. Clinical judgment should be used for low or high exposures.

  For more information on alcohol unit used, see description of units used in calculation and Canadian Alcohol Guidelines

• Smoking:
  

  Patient currently smokes tobacco. This risk factor appears to have a dose-dependent effect, i.e. the higher the exposure, the greater the risk. This is not taken into account and the computations assume average exposure. Clinical judgment should be used for low or high exposures.

• Femoral neck BMD (g/cm2):
  

  (BMD) Please select the make of DXA scanning equipment used and then enter the actual femoral neck BMD (in g/cm2). Alternatively, enter the T-score based on the NHANES III female reference data. In patients without a BMD test, the field should be left blank. The reference site and technology is DXA at the femoral neck. T-scores are based on the NHANES reference values for women aged 20-29 years. The same absolute values are used in men.