Determining fracture risk accurately is key to targeting osteoporosis intervention to persons at high risk while avoiding overtreatment. In the first part of my talk I will focus on risk – relative or absolute, cumulative, competing, imminent etc to try to clarify the terms and address some potential misunderstandings. For example, competing risk may be more important in the public health area than when advising the individual person. Some terms may not be used in a consistent way - Imminent fracture risk typically refers to the risk of suffering a fracture within a time window of two years. Very high fracture risk is commonly not set as a specific percent risk but as an age punitive sloping threshold so that a higher risk is accepted in the older person.
A host of imaging modalities can detect existing fractures and measure bone density and structural parameters, which contribute to the determination of fracture risk. However, most devices have low portability and relatively high cost, limiting availability in low- or medium-income countries. Improvements (with added complexity) are now being made to FRAX, FREM and other tools and ML is gradually being tested and employed, raising exciting possibilities but also multiple new issues.
Directions for future research will be discussed. The field may need to work towards lightweight high-performance tools that can help us better identify persons at high risk of fracture efficiently and inexpensively with health equity and low bias, before serious osteoporotic fractures are sustained.