WHO fracture risk assessment tool (FRAX)

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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


Last reviewed 07/2021