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FRAX Score: Assess Your 10-Year Fracture Risk

The FRAX Score is a WHO-developed tool for estimating the 10-year fracture risk in patients with osteoporosis. It supports clinical treatment decisions.

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Things worth knowing about "FRAX Score"

The FRAX Score is a WHO-developed tool for estimating the 10-year fracture risk in patients with osteoporosis. It supports clinical treatment decisions.

What is the FRAX Score?

The FRAX Score (Fracture Risk Assessment Tool) is a clinical instrument developed by the World Health Organization (WHO) and the University of Sheffield to estimate an individual's probability of experiencing an osteoporotic fracture within the next 10 years. It provides two percentage-based outputs: the likelihood of a hip fracture and the likelihood of a major osteoporotic fracture (involving the spine, forearm, hip, or shoulder).

Risk Factors Included in the FRAX Score

The FRAX Score integrates several well-established clinical risk factors. It can be used with or without a bone mineral density (BMD) measurement from a DXA scan (dual-energy X-ray absorptiometry), making it a flexible tool for primary care settings.

Clinical Risk Factors

Age and sex
Height and weight (used to calculate body mass index)
Previous fragility fracture after the age of 40
Parental history of hip fracture
Current smoking
Glucocorticoid use (e.g., cortisone for more than 3 months)
Rheumatoid arthritis
Secondary osteoporosis (e.g., type 1 diabetes, celiac disease, chronic liver disease)
Alcohol intake of 3 or more units per day
Femoral neck BMD (T-score) from a DXA scan (optional)

How is the FRAX Score Calculated?

The score is calculated using the official online tool available at www.sheffield.ac.uk/FRAX. After entering the relevant patient data, the tool generates two probability values expressing the risk over the next 10 years. The model is country-specific, as fracture incidence and mortality rates vary internationally. Country-specific models are available for over 70 countries worldwide.

Clinical Use and Interpretation

The FRAX Score is primarily used to guide decisions regarding pharmacological treatment for osteoporosis. It is particularly valuable in patients with borderline bone density (osteopenia), where the clinical need for treatment is unclear.

Risk Categories

Low risk: Pharmacological therapy generally not required; lifestyle modifications recommended
Intermediate risk: Individualized decision-making; consider DXA measurement if not yet performed
High risk: Pharmacological treatment recommended (e.g., bisphosphonates, denosumab)

Specific intervention thresholds differ between national guidelines. Clinicians should refer to the relevant national recommendations when interpreting FRAX results in practice.

Advantages and Limitations of the FRAX Score

Advantages

Quick and easy to use in everyday clinical practice
Applicable without a DXA scan
Validated globally and calibrated to country-specific fracture epidemiology
Helps identify both undertreated and overtreated patients

Limitations

Does not account for fall risk or muscle weakness
Vertebral fractures without trauma are not captured
Some risk factors (e.g., glucocorticoid dose) are only approximately represented
Should not replace a comprehensive clinical assessment

References

Kanis JA et al. - FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis International, 2008; 19(4): 385-397.
National Osteoporosis Foundation (NOF) - Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington DC, 2022.
WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield - FRAX Fracture Risk Assessment Tool. Available at: https://www.sheffield.ac.uk/FRAX

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