FRAX

The introduction of the FRAX® algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of BMD. Since age-specific rates of fracture and death differ across the world, all FRAX models are calibrated with regard to the epidemiology of hip fracture (preferably from national sources) and mortality (usually UN source). Models are currently available for 78 nations or territories covering more than 80% of the world population. FRAX has been incorporated into more than 80 guidelines worldwide, although the nature of this application has been heterogeneous. The limitations of FRAX have been extensively reviewed. Relatively simple arithmetic procedures have been proposed, in order to address some of these limitations, which can be applied to conventional FRAX estimates to accommodate knowledge of: dose exposure to glucocorticoids; concurrent data on lumbar spine BMD; information on trabecular bone score (TBS); hip axis length; falls history; type 2 diabetes; immigration status; and recency of prior fracture.