Osteoporosis Risk Assessment Instrument (ORAI)
3-item clinical screening tool to identify postmenopausal women at risk of low bone mineral density (BMD) who should be referred for DEXA scanning. Considers age, weight, and oestrogen use. Score ≥9 = refer for DEXA.
Score interpretation
ORAI <9 — low risk of low BMD; routine care
→ No DEXA required currently; calcium (700–1,200 mg/day from diet) and vitamin D (10 mcg/day supplement); weight-bearing exercise; smoking cessation and limit alcohol; reassess in 2–3 years or if risk factors change (fracture, prolonged steroids, premature menopause)
ORAI ≥9 — increased risk of low BMD; DEXA scanning recommended
→ Refer for DXA bone density scan; if T-score ≤-2.5: osteoporosis confirmed → bisphosphonate (alendronate first-line); if T-score -1 to -2.5: osteopenia → calcium, vitamin D, lifestyle; calculate FRAX score for 10-year fracture risk; falls risk assessment; consider vertebral fracture assessment; review bone-affecting medications (steroids, PPIs, antiepileptics)
Interpretation bands for the ORAI. Apply clinical judgement and local guidance.
References
- Cadarette SM et al. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162(9):1289–1294.
Related
Curated clinical cross-links plus same-class fallbacks.
- Denosumab · Anti-RANKL Monoclonal Antibody
- Denosumab · RANK Ligand Inhibitor (Anti-resorptive)
- Alendronic Acid (Alendronate) · Bisphosphonate (bone resorption inhibitor)
- Zoledronic Acid · IV Bisphosphonate
- Ciprofloxacin with dexamethasone · Topical otic antibiotic + corticosteroid
- Zoledronic Acid · Bisphosphonate
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- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.