Fig. 1

Infographic outlining the four osteoporosis risk categories. Initial risk assessment relies on using FRAX with clinical risk factors alone. Two intervention thresholds are identified. FRAX probability in the red zone, above intervention threshold (2) indicates very high risk. For this group of people, an initial course of anabolic therapy followed by anti-resorptive treatment may be appropriate. FRAX probability in the green zone suggests low risk, with advice to be given regarding lifestyle, calcium, and vitamin D supplementation. FRAX probability in the intermediate (yellow) zone should be followed by BMD assessment and recalculation of FRAX probability including femoral neck BMD. After recalculation, if the risk got in the red zone above intervention threshold 2, this indicates very high-fracture risk, whereas if the risk got in between intervention threshold 1 and below intervention threshold 2, this would indicate high risk, which suggests initial anti-resorptive therapy. If the risk lies below the intervention threshold 1, this would indicate low risk (management would be similar to green zone. Patients with a prior fragility fracture are designated either at high risk or possibly at very high risk dependent on the FRAX probability (amended from Fig. 1 published in Kanis, J.A., Harvey, N.C., McCloskey, E. et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int 2020; 31: 1–12 (quoted under open access scheme)