Screening for Osteoporotic Fractures in the Elderly: Current Guidelines and Future Directions.

Osteoporotic fragility fractures are a major health concern causing increased morbidity and mortality in the elderly population. Major risk factors for fragility fractures include, but are not limited to, advanced age, low Bone Mineral Density (BMD), and a personal or familial history of a prior adult fragility fracture. Additional factors, such as chronic oral corticosteroid use and a history of recurrent falls, have also been identified to be important risk factors in the development of fragility fractures in the elderly. Current Canadian screening and treatment guidelines are based on regular BMD testing to identify individuals at risk; however, emerging evidence continues to emphasize the importance of analysis of the many risk factors for fragility fractures in combination with BMD measurements. Risk factor assessment tools, such as the FRAX tool developed by the World Health Organization, are promising new methods for screening and preventative care of the elderly. In addition, changes in screening methodology within the family practice setting, such as the utilization of specific electronic medical record templates for the elderly, are potential directions for improving screening of fragility fractures in the elderly patient population.