An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis

FRAX (R), a simple-to-use fracture risk calculator, was first released in 2008 and since then has been used increasingly worldwide. By calculating the 10-year probabilities of a major osteoporotic fracture and hip fracture, it assists clinicians when deciding whether further investigation, for example a bone mineral density measurement (BMD), and/or treatment is needed to prevent future fractures. In this review, we explore the literature around osteoporosis and how FRAX has changed its management. We present the characteristics of this tool and describe the use of thresholds (diagnostic and therapeutic). We also present arguments as to why screening with FRAX should be considered. FRAX has several limitations which are described in this review. This review coincides with the release of a version, FRAXplus, which addresses some of these limitations.

Automated summary

FRAX is a simple-to-use fracture risk calculator that assists clinicians in determining the need for further investigation and treatment to prevent fractures. This review explores the literature on osteoporosis and how FRAX has changed its management, presenting the characteristics of the tool and discussing the use of thresholds. Arguments for considering screening with FRAX are presented, along with an assessment of the limitations of FRAX.