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, 1 out of 2 females assigned at birth (FAAB) over the age of 50 will have a fracture related to osteoporosis. Males assigned at birth (MAAB) are also more likely to fracture a bone as they age.

To help determine your risk for such an injury, doctors developed the FRAX. Your FRAX score is your risk of having 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.

Learn more about the chance of bone fractures from osteoporosis.

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: Having low weight and being frail raise your risk 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. Unfortunately, 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.

A FRAX score of more than 5% for a hip fracture at age 70 and beyond 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.

A breakdown of the scores by country is available on the FRAX website. 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.

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 several 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 is also used to treat osteoporosis. Usually, these hormone-related therapies accompany other treatments and lifestyle improvements. Lifestyle changes include increasing your vitamin D and calcium intake from food, supplements, or both.

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 fracture chance, such as osteoporosis, can help.

What should your FRAX score be?

A normal FRAX score is when the chance of getting a fracture in the next decade is less than 10%.

What is a moderate risk FRAX score?

Moderate risk for fractures is defined as between 10% and 20% chance of getting a fracture in the next decade.

What FRAX score indicates osteoporosis?

The Bone Health and Osteoporosis Foundation (BHOF)’s treatment guidelines state that a patient should be diagnosed with osteoporosis if their 10-year risk of hip fracture is 3% or higher or if they have a 20% chance or greater of experiencing a major osteoporotic fracture, as calculated by FRAX.

In general, a bone density test is recommended for FAABs starting at age 65 and MAABs at age 70. However, your doctor may suggest one earlier if you have a history of fractures or a family history of bone problems.

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.