WHO fracture risk assessment tool (FRAX)

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

Reference:

• 1. FRAX . WHO Fracture Risk Assessment Tool.
• 2. National Osteoporosis Foundation 2010. Clinician's guide to prevention and treatment of osteoporosis