What is the sensitivity of the WHO fracture-risk algorithm (FRAX) for perimenopausal and early-menopausal women?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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The FRAX tool has a low sensitivity for predicting fracture risk in perimenopausal and early-menopausal women. In a study by Trémollieres et al, FRAX had 50% sensitivity in the 30% of women in the study who were at the highest risk. [98] FRAX also does not include risk of falls; 90% of hip fractures [99] and the majority of Colles fractures are associated with falls. [100]  

The Garvan fracture risk tool is not as widely used as the FRAX but is another validated fracture prediction tool that does account for falls, and maybe a better tool for use in men. [101] However, the Garvan fracture does not include variables like parental history of hip fracture, secondary osteoporosis, rheumatoid arthritis, glucocorticoid use, smoking, or intake of alcohol which are included in the FRAX tool. [102]

Another fracture risk assessment tool is the Qfracture tool history of smoking, alcohol, corticosteroid use, parental history, and secondary causes of osteoporosis but unlike the FRAX tool, it includes history of falls but does not include BMD. [102]

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