Glossary · Tests

FRAX (Fracture Risk Assessment Tool)

Also called: Fracture Risk Assessment Tool.

Definition: FRAX is a clinical tool that estimates an individual's 10-year risk of major osteoporotic fracture (hip, spine, forearm, shoulder) and 10-year hip fracture risk. It combines age, sex, BMI, country, fracture history, parental hip fracture, smoking, alcohol, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, and DEXA femoral neck T-score. Results guide treatment decisions in osteopenia.

Detailed definition

FRAX was developed by the WHO Collaborating Centre at the University of Sheffield and is the most widely used fracture risk calculator. It is freely available at frax.shef.ac.uk and integrated into many DEXA reports. The output is two probabilities: 10-year major osteoporotic fracture risk (MOF) and 10-year hip fracture risk. National Osteoporosis Foundation/Bone Health and Osteoporosis Foundation thresholds for treating osteopenia in postmenopausal women are MOF ≥20% or hip fracture risk ≥3% over 10 years. FRAX has limitations: it does not account for spine BMD (only femoral neck), it does not adjust for fall history, and it cannot incorporate dose-response for risk factors (e.g., 1 cigarette/day vs. 2 packs/day).

Why it matters in menopause

FRAX turns "your DEXA shows osteopenia" into actionable risk stratification. For a 65-year-old with osteopenia and several risk factors, FRAX may indicate fracture risk high enough to warrant pharmacologic therapy. For a 55-year-old with osteopenia and no other risk factors, FRAX may indicate that lifestyle measures plus monitoring are appropriate.

Sources

External references: Wikipedia.

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