ANALYSIS OF THE CONCEPT OF RISK APPLIED TO THE RISK OF OSTEOPOROTIC FRACTURES

Abstract

The clinician uses the concept of risk in three circumstances: a) when he wishes to induce the patient to accept a therapeutic intervention, b) in the assessment of the results of a therapeutic trial, and c) in the assessment or qualification of diagnostic tests, that may be selected on account of their sensitivity, specificity and positive predictive value. This article presents an analytical review of the concept of risk in relation with osteoporotic hip fracture, discussing the elements included in the definitions of relative risk, absolute risk and associated variables. The risk of fracture is assessed usually by the data provided by DXA machines. With increasing insistence, epidemiological studies published in the last 15 years have shown the importance of the accumulation of clinical risk factors and their association with low bone mass or fragility fractures. The evidence is being assessed by the WHO Scientific Group Meeting of Fracture Risk Reporting, with the purpose of improving the information produced by densitometers, including the weight of risk factors in the report. Initial conclusions, published by members of the Group are included in the discussion. The review ends with an appraisal of the communication of risk to the patient.