FRAX Fracture Risk Assessment
When to use FRAX for 10-year fracture risk assessment. FRAX is proprietary; open the official University of Sheffield tool for country-specific models.
Overview
- FRAX estimates the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip, or shoulder) and of hip fracture alone.
- Models are country-specific. Choose the FRAX country tool that matches the patient’s setting.
- Optional femoral neck BMD can be entered when a DXA result is available; clinical risk factors alone still produce a probability.
Proprietary tool
- FRAX is a proprietary algorithm owned by the University of Sheffield. BetterCall does not compute FRAX percentages in-app.
- Open the official tool below for 10-year probabilities. Do not treat third-party recreations as FRAX.
When to use
- Bedside prompts for fracture risk assessment: prior fragility fracture, unexplained height loss or vertebral deformity, long-term oral glucocorticoids, or other clinical concern about bone health.
- Useful when deciding whether DXA or bone protection needs discussion with the treating team or GP, alongside falls risk and secondary causes.
- Not a substitute for local pathways, specialist advice, or full osteoporosis workup when indicated.
Inputs to gather
- Age and sex.
- BMI, or height and weight (see BMI calculator).
- Prior fragility fracture (yes / no).
- Parent fractured hip (yes / no).
- Current smoking (yes / no).
- Long-term oral glucocorticoids (yes / no).
- Rheumatoid arthritis (yes / no).
- Secondary osteoporosis causes (yes / no), e.g. type 1 diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism, premature menopause, chronic malnutrition or malabsorption, chronic liver disease.
- Alcohol 3 or more units per day (yes / no).
- Optional: femoral neck BMD (T-score) if DXA is available.
Caveats
- FRAX has age and BMI limits defined by the official tool; check the website if values fall outside the accepted range.
- Results are decision support only. Clinical judgement, falls risk, life expectancy, and patient preference still matter.
- Patients already on bone-protection therapy need a different approach than untreated risk assessment.
- A high FRAX probability does not replace investigation for secondary causes of osteoporosis or recent fracture when clinically indicated.
Related NICE guidance
NICENICE CG146 — Osteoporosis: assessing the risk of fragility fracture
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
External resources
Educational reference only. Medical disclaimer