WHO fracture risk assessment tool (FRAX)
After studying population-based cohorts from Europe, North America, Asia and Australia, the WHO has developed a tool (FRAX) which is able to evaluate fracture risk of a patient (1).
- the tool is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck
- it gives the 10 year probability of a fracture - hip fracture and of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture)
Clinical risk factors used in the WHO FRAX tool include:
- current age
- gender
- a prior osteoporotic fracture - including a morphometric vertebral fracture, prior clinical vertebral fracture or a hip fracture is an especially strong risk factor
- femoral neck BMD
- low body mass index
- oral glucocorticoids for more than 3 months at a dose of prednisolone of 5mg daily or more (or equivalent doses of other glucocorticoids)
- current smoking
- parental history of hip fracture
- alcohol intake (3 or more units a day)
- rheumatoid arthritis
- secondary osteoporosis e.g. - type I diabetes, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption etc.
The tool is available on WHO Fracture Risk Assessment Tool site
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