Epidemiology of fracture risk in the Women's Health Initiative.

Osteoporosis is one of the most disabling consequences of aging in women. Strategies that permit earlier identification of women at risk for fracture are needed. The Women's Health Initiative has extended our knowledge of clinical risk factors and biomarkers of fracture risk in postmenopausal women. Based upon 11 clinically available risk factors (age, race/ethnicity, self-reported health, weight, height, physical activity, parental hip fracture, fracture history after age 54, current smoking, corticosteroid use, and history of treated diabetes), an algorithm has been developed to predict 5-year hip fracture risk. Biomarkers including low vitamin D or bioavailable testosterone and/or high cystatin C or sex hormone-binding globulin also predict risk for hip fracture independent of clinical risk factors. To address the growing incidence of fractures in minority women, clinical risk factors for fracture have been identified. These data demonstrate that we can better identify women, irrespective of race or ethnicity, at risk for fracture.