Table 5.

Risk factors for osteoporosis/ fractures not presently accommodated in FRAX

• Thoracic kyphosis

• Height loss (>4 cm)

• Type 2 diabetes

• Falls

• Inflammatory disease: ankylosing spondylitis, other inflammatory arthritides, connective tissue diseases

• Endocrine disease: hyperthyroidism, hyperparathyroidism, Cushing’s disease

• Haematological disorders/malignancy

• Muscle disease: myositis, myopathies and dystrophies

• Asthma, chronic obstructive pulmonary disease

• HIV infection

• Neurological/ psychiatric disease, e.g. Parkinson’s disease, multiple sclerosis, stroke, depression, dementia

• Nutritional deficiencies: calcium, vitamin D, magnesium, protein (note that vitamin D deficiency may contribute to fracture risk through undermineralisation of bone (osteomalacia) rather than osteoporosis)

• Medications

• Some immunosuppressants (calmodulin/calcineurine phosphatase inhibitors)

• (Excess) thyroid hormone treatment (levothyroxine and/or liothyronine). Patients with thyroid cancer with suppressed TSH are at particular risk

• Drugs affecting gonadal hormone production (aromatase inhibitors, androgen-deprivation therapy, medroxyprogesterone acetate, gonadotrophin hormone releasing agonists)

• Some antidiabetic drugs

• Some antipsychotics

• Some anticonvulsants

• Proton pump inhibitors