In the past the management of osteoporosis centred on the use of diagnostic thresholds based on bone mineral density (BMD) measured at the spine or hip by dual x-ray absorptiometry (DXA). More recently it has been found that the presence of several clinical risk factors is associated with a fracture risk greater than can be accounted for by BMD alone. Assessment of fracture risk therefore needs to take into account specific risk factors that contribute to fracture risk as well as BMD. [With external links to the evidence base]