The 10-year probability of fracture in an individual can be calculated using the FRAX® fracture risk assessment tool. FRAX is available online  or as a paper model. The calculation of fracture risk, as well as utilization in management algorithms, is country-specific.
In a recent article , Kanis and colleagues explain that FRAX was developed using clinical risk factors, with and without bone mineral density, as identified in previous meta-analyses. Risk factors comprised age, sex, body mass index, a prior history of fracture, parental history of hip fracture, use of oral glucocorticoids, rheumatoid arthritis and other secondary causes of osteoporosis, current smoking and alcohol intake three or more units daily. The 10-year probability of fracture is expressed as a percentage for any major osteoporotic fracture or hip fracture. In a second publication , Kanis and colleagues used FRAX and a prior study on the cost-effectiveness of generic alendronate to determine a fracture intervention threshold. Treatment was cost-effective at all ages if the 10-year probability of a major osteoporotic fracture exceeded 7%.
Tobie J. de Villiers
Consultant Gynaecologist, Panorama MediClinic, Cape Town South Africa
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97. Published April, 2008.
Kanis JA, McCloskey EV, Johansson H, et al. Case finding for the management of osteoporosis with FRAX assessment and intervention thresholds for the UK. Osteoporos Int 2008;19:1395-408. Published October, 2008.