Fracture Risk Assessment

Scientific research now supports the use of proven therapies to prevent osteoporotic fractures based on the individual's probability of fracture as opposed to their bone density score alone (2). This relatively new concept has been validated to ensure its accuracy and reproducibility by a WHO working group (established in 1998) in collaboration with IOF and the (US) National Osteoporosis Foundation.

The result is an easy-to-use fracture risk assessment tool for family physicians to use with patients of both sexes called FRAX®  - Fracture Risk Assessment Tool. The web-based FRAX calculator assesses the ten-year risk of osteoporosis fracture based on specific individual risk factors, with or without BMD values. Currently, there are separate country models for more than 60 individual countries and it is available in more than 30 languages.

IOF provides various FRAX resources to make knowledge of FRAX and use of the FRAX calculator more easily accessible in all clinical settings.

Risk Factors

In the course of a clinical examination a physician will consider a patient's various skeletal and non-skeletal risk factors as part of an overall case-finding strategy and in order to come to any treatment decision(3). FRAX captures many of these risk factors, but not all. Common risk factors include:

Non-skeletal factors

  • Cigarette smoking (4)
  • Excessive alcohol consumption (5)
  • Low body mass index (BMI)
  • Low dietary calcium intake
  • Vitamin D deficiency
  • Prolonged immobilisation – Little or no physical activity
  • Visual impairment
  • Frequent falls

Skeletal factors

  • Female gender
  • Premature menopause
  • Primary or secondary amenorrhoea
  • Primary and secondary hypogonadism in men
  • Age(6)
  • Asian or Caucasian race
  • Previous fragility fracture (7)
  • Family history of hip fracture (8)
  • Low BMD
  • High bone turnover
  • Neuromuscular disorders
  • Glucocorticoid long-term therapy (9)
  • Rheumatoid arthritis