FRAX — Fracture Risk Assessment (Simplified)
Simplified FRAX-based osteoporosis risk assessment. Full FRAX requires BMD; this tool identifies candidates for DXA scanning.
How to use & interpret
FRAX estimates the 10-year probability of a major osteoporotic fracture and of hip fracture from clinical risk factors (age, sex, BMI, previous fracture, parental hip fracture, smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis and alcohol), with or without a femoral-neck bone density (BMD) result.
In the UK the output is interpreted against NOGG thresholds to decide on reassurance, BMD measurement, or treatment. FRAX informs but does not dictate the decision, and it has recognised limitations (e.g. it does not capture dose of steroids, number/recency of fractures, or falls risk).
Score interpretation
Score 0–2: Low osteoporosis risk
→ Calcium 1000 mg/day + vitamin D; exercise; fall prevention; reassess in 5 years
Score 3–5: Moderate osteoporosis risk
→ Refer for DXA scan; calcium + vitamin D; assess full FRAX with BMD; consider bisphosphonate if T-score ≤–2.5
Score ≥6: High fracture risk
→ DXA scan urgently; start bisphosphonate if not contraindicated; calcium + vitamin D; falls referral; DEXA-guided FRAX for 10-year risk
Interpretation bands for the FRAX Simplified. Apply clinical judgement and local guidance.
Frequently asked questions
Do I need a bone density scan to use FRAX?
No — FRAX can be calculated without BMD and is often used first to decide who needs a DXA scan; adding the femoral-neck BMD refines the estimate.
References
- Kanis JA, et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385-397.
Related
Curated clinical cross-links plus same-class fallbacks.
- Alendronic Acid (Alendronate) · Bisphosphonate (bone resorption inhibitor)
- Zoledronic Acid · IV Bisphosphonate
- Zoledronic Acid · Bisphosphonate
- Denosumab · Anti-RANKL Monoclonal Antibody
- Ibandronate · Bisphosphonate (Osteoporosis)
- Pamidronate Disodium · IV Bisphosphonate (Paget's Disease / Bone Metastases / Hypercalcaemia)
- Cutaneous Lupus Erythematosus · BAD; EULAR
- Osteoporosis / Fragility Fracture · NOGG 2021; NICE NG147; NG224
- Arteritic AION (Giant Cell Arteritis) · RCOphth; BSR
- Osteoarthritis Hip / Knee Management · NICE NG226 (2022)
- Lupus Nephritis · EULAR/ERA-EDTA 2019; KDIGO 2024
- Rheumatoid Arthritis Management · NICE CG79 2018 / EULAR 2022
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.