REVIEW – June 2009

FRAX – tool for fracture risk assessment


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Osteoporosis is an important public health concern because of involved fractures. FRAX is a tool for identifying people at the highest risk of fractures and it can be applied in clinical settings. Bone mineral density (BMD) is a strong predictor for fracture risk. However, the majority of fractures occur in women with BMD above osteoporosis threshold (osteopenia). Additional risk factors should be taken in account. One important risk factor is age; fracture probability is age and BMD specific, other  risk factors include body mass index, previous hip fractures, current smoking, use of glycocorticoids, use of alcohol 3 or more units per day and several clinical conditions leading to secondary osteoporosis. Accumulation of risk factors increases fracture probability. The risk of osteoporotic fractures is different in different countries. FRAX is not validated in Estonia. The principles of the FRAX algorithm are recommended to be introduced by physicians in daily clinical decision making in Estonia.