Understanding the FRAX Tool
The Fracture Risk Assessment Tool (FRAX), developed by the World Health Organization (WHO), is designed to help estimate a person's 10-year likelihood of experiencing a major osteoporotic or hip fracture. This tool uses clinical risk factors for a personalized estimate. It is not a diagnostic tool for osteoporosis on its own and is typically used alongside other assessments like a bone mineral density (BMD) test.
The US Treatment Thresholds
In the United States, guidelines from the National Osteoporosis Foundation (NOF) assist in interpreting FRAX scores. The FRAX tool is recommended for postmenopausal women and men aged 50 and older who have low bone mass (osteopenia).
Treatment for osteoporosis may be considered if the FRAX score indicates either:
- A 10-year probability of hip fracture of 3% or higher.
- A 10-year probability of a major osteoporotic fracture of 20% or higher.
These are guidelines; a comprehensive assessment by a healthcare provider is essential.
How Your FRAX Score Is Calculated
The FRAX calculation incorporates various factors influencing fracture risk, including age, sex, weight/height, prior fractures, parental hip fracture history, smoking, glucocorticoid use, rheumatoid arthritis, other medical conditions, alcohol intake, and optionally, BMD from a DXA scan. Including BMD significantly improves accuracy.
FRAX vs. DXA: A Comparison
FRAX and DXA scans serve distinct purposes.
| Feature | FRAX Score | DXA Scan (T-Score) |
|---|---|---|
| Purpose | Estimates 10-year fracture probability | Measures bone mineral density (BMD) |
| Calculation | Uses clinical risk factors and optional BMD | Uses X-rays to measure bone density |
| Output | Two percentage scores (major fracture, hip fracture) | T-score compared to a healthy young adult |
| Scope | Predictive, includes multiple clinical factors | Diagnostic tool based on BMD |
| Optimal Use | Assessing fracture risk, particularly with osteopenia | Diagnosing osteoporosis and tracking BMD changes |
The FRAX score's predictive power is enhanced with a DXA T-score. The tool can also help determine if a DXA scan is needed.
Beyond the Score: Other Critical Risk Factors
Additional factors not fully captured by FRAX, such as fall history, specifics of prior fractures, higher dose/longer duration glucocorticoid use, and certain health conditions like type 2 diabetes, are also considered by doctors when assessing risk. Fall history is a particularly significant predictor.
Lifestyle and Prevention
Maintaining bone health involves healthy lifestyle habits:
- Healthy diet: Ensure adequate calcium and vitamin D.
- Weight-bearing exercise: Helps build and maintain bone density.
- Avoid smoking and limit alcohol: Negative impacts on bone health.
- Prevent falls: Improve home safety and balance.
- Consult your doctor: Discuss all risk factors and options.
Conclusion
While FRAX doesn't diagnose osteoporosis, the thresholds of ≥3% for hip fracture and ≥20% for major osteoporotic fracture are key indicators for considering treatment in eligible individuals. These cutoffs, along with T-scores and other clinical factors, inform healthcare decisions on managing fracture risk. The FRAX score is a valuable tool in bone health strategy. For more information, visit {Link: Bone Health and Osteoporosis Foundation https://www.bonehealthandosteoporosis.org/patients/diagnosis-information/risk-assessment-frax/}.
