The risk of further fractures increases 2–10 times after the first fracture. Actual fracture risk for the given person (absolute fracture risk) can be calculated from data collected in 10-year prospective studies (NHANES or Kanis 2001). To calculate absolute fracture risk one has to multiply age-related risk factor ascertained in above studies by the coefficient estimated for particular factors influencing possible fracture (relative fracture risk). The most commonly used factors are: age (RR 2.0 for each 5 yrs over 65), low BMD (RR/SD 1.4–2.6), low-energy fracture after the age of 40 (RR 4.0), proximal femur fracture in mother (*RR 1.9), body mass lower than 58 kg (*RR 1.9), early menopause – before the age of 45, smoking (RR 1.2), susceptibility to falls (*RR 3.5), corticosteroids intake.

Absolute fracture risk in 60-year-old woman whose foreseen 10-year probability of femoral neck fracture is 2.3% with normal BMD but burden by factors marked by asterisks would be: 2.3% x 1.9 x 1.9 x 3.5 = 29%. As 76% of fractures occur in women with normal BMD absolute fracture risk is the most objective information. In case of proximal femoral fracture 10-year probability of 10% or more fracture risk provides a cost effective threshold for women in Sweden.

We can increase bone mineral density by pharmacological intervention. Every patient should be given calcium and vit. D supplementation and a specific medication, which should be adjusted to: age, sex and presence of hot flashes and fractures. HRT is preferred in women aged 50–60 yrs suffering from hot flashes. HRT decreases the risk of spine (50%) and proximal femur fracture (40%). However some risk of breast and uterine cancer has to be taken into consideration. Selective estrogen modulators (SERM; raloxifene) act as estrogen agonists on bone and cardiovascular system but as antagonists on breast tissue. Decrease of spinal fracture (45%) and breast cancer incidence (70%) is proven but no positive action on proximal femur is reported.

In women who underwent osteoporotic fracture one can apply bisphosphonates, strontium ranelate or PTH. Alendronate reduces spine fractures (47%) and proximal femur fractures (51%). Similar effects are documented for risedronate (spine – 60% and proximal femur 40–56%). Strontium ranelate not only inhibits bone resorption but also stimulates bone formation. Decrease of spine and proximal femur fractures occurrence has been proven (41%). PTH injected sc. in daily doses is the most powerful compound which rebuilds bone trabeculae in severe cases and reduces incidence of peripheral fractures (53%). Calcitonin is effective in spine fractures but not in proximal femur.

Fall prevention program should be implemented in all patients with osteoporosis independently from pharmacological intervention.