What is the WHO fracture-risk algorithm (FRAX)?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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The World Health Organization fracture-risk algorithm (FRAX) was developed to calculate the 10-year probability of a hip fracture and the 10-year probability of any major osteoporotic fracture (defined as clinical spine, hip, forearm, or humerus fracture) in a given patient. These calculations account for femoral neck BMD and other clinical risk factors, as follows [95] :

  • Age
  • Sex
  • Personal history of fracture
  • Low body mass index
  • Use of oral glucocorticoid therapy
  • Secondary osteoporosis (eg, coexistence of rheumatoid arthritis)
  • Parental history of hip fracture
  • Current smoking status
  • Alcohol intake (three or more drinks per day)

The National Osteoporosis Foundation (NOF) recommends osteoporosis treatment in patients with low bone mass in whom a US-adapted WHO 10-year probability of a hip fracture is 3% or more or in whom the risk for a major osteoporosis-related fracture is 20% or more. [4] Note that osteoporosis is, by definition, present in those with a fragility fracture, irrespective of their T-score.

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