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FRAX fracture risk assessment tool

Calculates 10-year probability of a fracture based on 1) clinical risk factors a) family history - 1st degree relative with history of hip fracture b) alcohol & tobacco use c) low body mass d) glucocorticoid use e) personal history of fracture 2) bone mineral density (BMD) if available [3] - controversy whether BMD improves calculation of risk [3] Radiology: - bone mineral density assessment (DEXA) indicated if FRAX score >= 9.3% [5,6] Management: - bisphosphonate indicated if - risk of osteoporotic fracture is >= 20% - risk of hip fracture >= 3% [5] Notes: - ref [3] seems suggest a calculation without BMD is appropriate - may underestimate fracture risk in elderly with multiple previous fractures [3]

Related

minimal trauma (pathologic, osteoporotic, fragility, insufficiency) fracture QFracture score

General

risk calculator numerical rating scale (NRS)

References

  1. Prescriber's Letter 15(4): 2008 New guideline for prevention and treatment of osteoporosis from the National Osteoporosis Foundation Detail-Document#: 240404 (subscription needed) http://www.prescribersletter.com
  2. Kanis JA, Oden A, Johansson H, et al. FRAX and its application to clinical practice. Bone 2009; 44:734-743 PMID: 19195497 - Kanis JA, McCloskey EV, Johansson H et al Development and use of FRAX in osteoporosis. Osteoporos Int. 2010 Jun;21 Suppl 2:S407-13. PMID: 20464374 - Kanis JA, Hans D, Cooper C et al Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011 Sep;22(9):2395-411. Review. PMID: 21779818
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. Tamaki J, Iki M, Kadowaki E et al Fracture risk prediction using FRAX : a 10-year follow-up survey of the Japanese Population-Based Osteoporosis (JPOS) Cohort Study. Osteoporos Int. 2011 Dec;22(12):3037-45. PMID: 21279504
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 201
  6. U.S. Preventive Services Task Force Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement Annals of Internal Medicine, January 17, 2011 PMID: 21242341 http://www.annals.org/content/early/2011/01/13/0003-4819-154-5-201103010-00307.full
  7. The risk calculator is available online at: https://www.sheffield.ac.uk/FRAX/