What is the risk threshold that is appropriate for intervention?
That threshold is partly dependent on a person’s perception of risk of fracture and should be discussed with a doctor. In broad terms, however, we consider that a 5-year risk of >10% is high, 5-10% is moderate, and <5% is low. Based on 35-50% risk reduction from ant-fracture treatment such as bisphosphonates, the cost per fracture prevented seems reasonable at a 5-year risk of 10% or 10-year risk of 20% or greater [19-20]. This threshold is also used in cardiovascular disease prevention (National Cholesterol Education Program) and has been adopted by expert osteoporosis groups [12] and recommended by panel of osteoporosis experts [21]. Given the undertreatment and underdiagnosis of osteoporosis [22], it is hoped that this prognostic model will help to improve the uptake of treatment and reduce the burden of osteoporosis in the general population.
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