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FRAX
Specialty	Endocrinology, Rheumatology
Symptoms	Increased risk of osteoporotic fractures
Complications	Fractures, osteoporosis
Risk factors	Age, gender, family history, smoking, alcohol use, glucocorticoid therapy
Diagnostic method	FRAX tool
Treatment	Lifestyle modification, medication

FRAX (Fracture Risk Assessment Tool) is a diagnostic tool used to evaluate the 10-year probability of bone fractures in individuals. It was developed by the World Health Organization (WHO) and is widely used in clinical practice to assess fracture risk in patients with osteoporosis and other conditions that affect bone health.

Development and Purpose

The FRAX tool was developed by the WHO Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield, UK. It was designed to provide a comprehensive assessment of fracture risk by integrating clinical risk factors with or without bone mineral density (BMD) values. The tool is intended to aid healthcare professionals in making informed decisions about the need for intervention in patients at risk of fractures.

Clinical Risk Factors

FRAX incorporates several clinical risk factors that contribute to fracture risk, including:

• Age
• Gender
• Body mass index (BMI)
• Previous fracture
• Parental history of hip fracture
• Current smoking
• Glucocorticoid therapy
• Rheumatoid arthritis
• Secondary causes of osteoporosis
• Alcohol consumption

Use of Bone Mineral Density

While FRAX can be used without BMD, the inclusion of BMD measurements, specifically at the femoral neck, enhances the accuracy of the risk assessment. BMD is typically measured using dual-energy X-ray absorptiometry (DXA).

Calculation and Interpretation

The FRAX tool calculates the 10-year probability of a major osteoporotic fracture (spine, forearm, hip, or shoulder) and the 10-year probability of a hip fracture. The results are presented as percentages, and thresholds for intervention may vary based on national guidelines and individual patient circumstances.

Clinical Application

FRAX is used by healthcare providers to:

• Identify patients at high risk of fractures who may benefit from preventive measures or treatment.
• Guide decisions regarding the initiation of pharmacological therapy for osteoporosis.
• Educate patients about their fracture risk and the importance of lifestyle modifications.

Limitations

While FRAX is a valuable tool, it has limitations, including:

• It does not account for all potential risk factors, such as falls or vitamin D deficiency.
• It may underestimate risk in certain populations, such as those with multiple fractures or very low BMD.
• The tool is based on population data and may not fully reflect individual risk.

Also see

• Osteoporosis
• Bone mineral density
• Dual-energy X-ray absorptiometry
• Rheumatoid arthritis
• Glucocorticoid therapy