The Fracture Risk Assessment Tool (FRAX) calculates your chance of getting a fracture in the next decade, taking into account multiple risk factors. The higher your score, the more likely it is you’ll get a fracture.

Because of the bone-weakening effects of menopause, one in two females assigned at birth (FAABs) over age 50 will get a fracture related to osteoporosis. Males assigned at birth (MAAB) are also more likely to fracture a bone as they age.

Doctors developed the FRAX to help determine one’s risk for such an injury. Your FRAX score is your chance of getting an osteoporosis-related fracture in the next 10 years.

Osteoporosis, which means “porous bone,” is a particular risk factor for fractures. Your bones become more brittle, usually due to hormonal changes or reduced levels of calcium or vitamin D. The loss of bone mass makes them weaker and more likely to break if you fall or are otherwise injured.

In a 2019 cohort study, researchers found that 21% and 16% of total fractures in women and men, respectively, were related to the disease. These percentages were higher in older adults.

A diagnosis of osteoporosis isn’t a guarantee that you’ll have a fracture. A bone mineral density (BMD) test can show how much weaker your bones have become. The FRAX score can give you a better idea of your risk.

Other risk factors

In addition, the formula that FRAX uses is based on several other factors that can increase your chance of a fracture. You can select those that apply to you in the FRAX questionnaire. For each country, the questionnaire can vary based on different risk factors.

For the United States, they include:

  • Age: being over 50 because the loss of bone mass increases as you age
  • Weight: Low weight and frailty raise the chance of osteoporosis. Your height-to-weight ratio can help determine how frail you are or whether you are too overweight.
  • Sex: FAABs have a higher chance of developing fractures, especially if they have osteoporosis and are older adults
  • Substance use: having a history of smoking and drinking too much alcohol or coffee
  • Vitamin deficiency: not having enough vitamin D or calcium
  • Exercise: not being physically active
  • Fracture history: Your FRAX score will be higher if you’ve had a fracture that occurred spontaneously. It will also be higher if you’ve broken a bone caused by trauma that would not usually cause a fracture in a healthy person.
  • Parent fractured hip: If your mother or father had a hip fracture, your risk of a similar injury is higher.
  • Glucocorticoids: These medications treat allergies, autoimmune conditions, and other health problems. But, they can also interfere with the formation of new bone tissue and with your absorption of calcium.
  • Bone mineral density (BMD): On the questionnaire, you must select what type of bone density scan you had and then fill in your score.

In addition, some conditions besides osteoporosis can increase the chance of fractures, such as:

After you or your doctor fills in your information on the questionnaire, your FRAX score will be calculated. You’ll receive a 10-year risk percentage of a major osteoporotic fracture and a 10-year risk percentage of a hip fracture.

Your score is then plotted on a graph that suggests whether you should get treatment or make lifestyle changes to manage your risk.

The FRAX website provides a breakdown of the scores by country. For the United States, the calculator also considers racial groups, which have different degrees of risk for fractures.

However, this is a corrective factor that was added to the calculator after it was built based on data from people who are white. According to some researchers, this can make the calculator less accurate for groups such as African Americans.

Other research confirms that the FRAX may not consider race sufficiently, contributing to the overall healthcare inequity.

A healthy FRAX score is when your chance of getting a fracture in the next decade is less than 20% or your chance of getting a hip fracture specifically is less than 3%.

What is the FRAX cut-off for DEXA?

Generally, a bone density test (DEXA) is recommended for FAABs starting at age 65 and MAABs at age 70, though some doctors may not recommend this for MAABs. However, your doctor may suggest one earlier if you have a history of fractures or a family history of bone problems. Speak with your doctor to determine whether this screening is right for you.

What FRAX score needs treatment?

A FRAX score of more than 3% for a hip fracture means you should consider treatment along with lifestyle changes. A lower FRAX score, but at a younger age, may also require treatment or a doctor’s supervision

If lifestyle changes are appropriate, your doctor may recommend:

  • more weight-bearing exercise
  • quitting smoking (if you smoke)
  • limiting alcohol

You will also be advised to reduce your fall risk in several ways. This means making your home safer by:

  • getting rid of throw rugs
  • installing grab bars if necessary
  • improving the floor lighting at night
  • wearing shoes that aren’t likely to slip

You may also be advised to work on balance exercises.

More aggressive treatment usually includes a medication called bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva).

Long-term use of these medications is associated with rare but serious side effects, including fractures and jawbone deterioration. Other drugs may be used, such as denosumab (Prolia) or zoledronic (Reclast), which are given by injection.

Estrogen-replacement therapy for FAABs and testosterone therapy for MAABs are also used to treat osteoporosis. These hormone-related therapies usually accompany other treatments and lifestyle improvements. Lifestyle changes include increasing vitamin D and calcium intake from food, supplements, or both.

Once you have a BMD measurement, you can get a FRAX score. If your risk of an osteoporotic fracture is high in the next few years, talk with your doctor about medications, supplements, lifestyle changes, and other options to reduce your risk and protect yourself from a fracture.

Some items on the FRAX score list of risk factors are manageable. You can lower your score and risk immediately by quitting smoking and reducing your alcohol consumption.

Getting more exercise, including weight-bearing activities, is helpful, too. And if you’ve been taking glucocorticoids for a long time, talk with your doctor about whether you can cut back or stop taking those medications altogether.

In addition, getting the proper treatment for any condition that raises your chance of fracture, such as osteoporosis, can help.