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Summary

What it measures:

The Fracture Risk Assessment Tool (FRAX) (1) is a fracture risk calculator that estimates an individual’s 10-year probability of incurring a hip or other major osteoporotic fracture. 

The FRAX® models were developed from and validated on population-based cohorts from 4 continents; charts are available for many countries. 

The tool can be used for the following US patient populations, white, black, Hispanic, and Asian.

Clinical role

The role of the PT and PTA in promoting bone health across the life span is summarized by Perry and Downey, (9) who suggest using the FRAX® tool for review of systems examination, referral, and treatment.

  • Examination:
    • The FRAX is not meant to be used for prediction if the patient is already receiving medical management for osteoporosis.
    • Patients with a high-fracture risk will benefit from a more thorough examination.

 

  • Referral:
    • Based on FRAX® calculation, refer patients with a 3% or higher probability of hip fracture or a 20% or higher probability of other major osteoporotic fracture.

 

  • Treatment:
    • Consult FRAX® scores to assist with the decision to prescribe exercise for bone strength and as additional rationale for reimbursement.

    There have been several limitations noted for the FRAX®. One limitation is that it does not include the patient’s history of falls, and the tool underestimates fracture risk in patients who are at an increased risk of fall. For this reason, Bolland et al (10) have recommended that FRAX be used as a primary tool for fracture prediction for those without a history of falls. But other prediction models, such as the Garvan Institute’s Fracture Risk Calculator (GARVAN), should be used in those who have significant fall risk. 

     

    In 2011, the United States Preventive Services Task Force (USPSTF) recommended routine screening for osteoporosis for all women aged 65 years and older, and endorsed use of the FRAX to identify screening candidates among younger postmenopausal women aged 50 to 64 years. (11) The recommended threshold score is 9.3%. (12) 

    Three clinical practice guidelines (13-15) specifically name the FRAX® tool as the tool for assessing absolute risk for fracture.


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