Fracture Risk Assessment (FRAX) Tool

Original Editor - Carin Hunter

Top Contributors - Carin Hunter and Kim Jackson  

Objective[edit | edit source]

FRAX is short for Fracture Risk Assessment Tool. This is primarily a screening tool and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture[1] and to target anti-osteoporosis treatments[2].

Any clinician can use this calculator[3] to predict the probability of an osteoporotic fracture within ten years in a patient.

Intended Population[edit | edit source]

The FRAX calculator is used to to evaluate fracture risk of patients and can be used by a healthcare professional within their clinical decision making process to know what intervention to best recommend. These interventions could incorporate pharmaceutical referral, an exercise program or nutritional changes.

Method of Use[edit | edit source]

To use the FRAX calculator, go to the FRAX calculator[3] on the Sheffield University website,

Click on the dropdown "CALCULATION TOOL" in the top panel and select the continent and country.

There are 2 components to the calculation

  1. The place you were born
  2. The place you currently live

The most accurate picture of bone health is to work out both scores and conduct a comparison. The initial calculation will give an idea of the genetic component while the second figure will incorporate information on your bone health related to sun exposure and diet.

The following information is then required

  • Age, date of birth, sex, weight and height
  • Previous and parent fracture history
  • Smoking status
  • Glucocorticoid steroid usage history
  • Rheumatoid arthritis
  • Secondary osteoporosis
  • Alcohol consumption
  • Femoral neck bone mineral density (BMD)

The results can then be calculated

FRAX Score Interpretation[edit | edit source]

After results have been calculated, you will see a "red box score". This shows the BMI and the 10-year probability of a fracture


In Exercise for Better Bones[5], the cardiovascular (or weight bearing) exercise recommendations fall into three categories:

  1. Low Fracture Risk.
  2. Moderate Fracture Risk.
  3. High Fracture Risk

How to Adjust the T-Score Result[edit | edit source]

The FRAX calculator is specific to populations and geographical locations. You may need to adjust your T-score for your patients particular demographic. The adjustment tool can be found online at the University of Washington[6] website

After adjusting the T-score, use the normalized T-score in the FRAX calculator to continue and get your FRAX score.


Margaret Martin, physical therapist, has created a video tutorial on how to convert the T-score to be more specific to your patient.

Limitations[edit | edit source]

  1. Medications are not considered. The FRAX calculator does not take into account the usage of medications that could affect bone health.
  2. Calcium, Vitamin D, Vitamin K levels not considered

New developments[edit | edit source]

FRAX was originally designed for use in the general population but recently clinicians have been applying the FRAX tool to individuals with special conditions.

Globally breast cancer is the most common cancer in women[7]. Aromatase inhibitor (AI) therapy is recommended to reduce the risk of cancer recurrence in postmenopausal women with hormone receptor–positive breast cancer[8] This treatment has been reported to increase bone turnover, bone loss, and fracture risk[9]. Denosumab is a pharmacutical options to prevent bone loss in AI users[10][11][12]. One paper has recommended FRAX for guidance on prevention of bone loss and fractures in postmenopausal women treated with AI for breast cancer [13]. The accuracy of this application is unknown as the FRAX tool was not designed for this application.[12]

Resources[edit | edit source]

FRAX ®Fracture Risk Assessment Tool developed by The University of Sheffield

References[edit | edit source]

  1. Kanis JA, Harvey NC, Johansson H, Liu E, Vandenput L, Lorentzon M, Leslie WD, McCloskey EV. A decade of FRAX: how has it changed the management of osteoporosis?. Aging clinical and experimental research. 2020 Feb;32(2):187-96.
  2. Kanis JA, Johansson H, Harvey NC, McCloskey EV. A brief history of FRAX. Archives of osteoporosis. 2018 Dec;13(1):1-6.
  3. 3.0 3.1
  4. 4.0 4.1
  7. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018 Nov;68(6):394-424.
  8. Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, Giordano SH, Hudis CA, Rowden D, Solky AJ, Stearns V. Adjuvant endocrine therapy for women with hormone receptor–positive breast cancer: American Society of Clinical Oncology clinical practice guideline focused update. Journal of clinical oncology. 2014 Jul 20;32(21):2255.
  9. Reid DM, Doughty J, Eastell R, Heys SD, Howell A, McCloskey EV, Powles T, Selby P, Coleman RE. Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer treatment reviews. 2008 Jan 1;34:S3-18.
  10. Gnant M, Pfeiler G, Dubsky PC, Hubalek M, Greil R, Jakesz R, Wette V, Balic M, Haslbauer F, Melbinger E, Bjelic-Radisic V. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet. 2015 Aug 1;386(9992):433-43.
  11. Greenspan SL, Vujevich KT, Brufsky A, Lembersky BC, van Londen GJ, Jankowitz RC, Puhalla SL, Rastogi P, Perera S. Prevention of bone loss with risedronate in breast cancer survivors: a randomized, controlled clinical trial. Osteoporosis International. 2015 Jun;26(6):1857-64.
  12. 12.0 12.1 Rizzoli R, Body JJ, De Censi A, Reginster JY, Piscitelli P, Brandi ML. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporosis international. 2012 Nov;23(11):2567-76.
  13. Leslie WD, Morin SN, Lix LM, Niraula S, McCloskey EV, Johansson H, Harvey NC, Kanis JA. Performance of FRAX in Women with Breast Cancer Initiating Aromatase Inhibitor Therapy: A Registry‐Based Cohort Study. Journal of Bone and Mineral Research. 2019 Aug;34(8):1428-35.