What is FRAX?

Because of the bone-weakening effects of menopause, 1 out of 2 women over the age of 50 will have a fracture related to osteoporosis. Men are also more likely to fracture a bone as they age.

To help determine your risk for such an injury, doctors developed the Fracture Risk Assessment Tool (FRAX). Your FRAX score is your risk of having an osteoporosis-related fracture in the next 10 years.

The formula for measuring your risk uses factors such as:

  • age
  • weight
  • gender
  • smoking history
  • alcohol use
  • fracture history

Osteoporosis means “porous bone.” Bones become more brittle, usually due to hormonal changes or reduced levels of calcium or vitamin D in the body. The loss of bone mass makes them weaker and more likely to break if you fall or are otherwise injured.

The primary test used to diagnose osteoporosis is dual X-ray absorptiometry (DEXA). A DEXA scan measures your bone mineral density (BMD). It’s a painless imaging test that uses low levels of radiation. During the test, you lie down and a scanner passes over your body. Some tests measure the BMD of the entire skeleton. Other types of DEXA scans check a few bones, such as the hips, wrist, and spine.

A diagnosis of osteoporosis isn’t a guarantee that you’ll have a fracture. A BMD test can only give you an idea of how much weaker your bones have become. A FRAX score can give you a better idea of your risk.

The FRAX questionnaire includes only 12 items. Each one, though, represents an important osteoporosis risk factor. The factors include:

  • Age. The loss of bone mass increases as you age.
  • Sex. Women are at a higher risk for osteoporosis and related fractures, but men can also develop osteoporosis.
  • Weight. Having low weight and being frail raise your risk of osteoporosis.
  • Height. Your height-to-weight ratio can help determine how frail you are or whether you are too overweight.
  • Previous fracture. 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.
  • Current smoking. Smoking is a controllable risk factor for osteoporosis and weaker bones.
  • Glucocorticoids. These medications are used to 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.
  • Rheumatoid arthritis. This autoimmune condition is associated with a higher risk of osteoporosis.
  • Secondary osteoporosis. This includes conditions related to osteoporosis, such as type 1 diabetes, hyperthyroidism, chronic liver disease, premature menopause (prior to age 45), and several other conditions.
  • Three or more alcoholic drinks per day. These include beer, wine, and spirits. Excessive alcohol consumption raises the risk of osteoporosis.
  • Bone mineral density (BMD). On the questionnaire, you must select what type of bone density scan you had and then fill in your score.

After you or your doctor fills in all 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 percent 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 at least a doctor’s supervision.

If lifestyle changes are appropriate, your doctor may recommend:

  • more weight-bearing exercise
  • quitting smoking
  • 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 type of 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 women and testosterone therapy for men are also used to treat osteoporosis. Usually these hormone-related therapies accompany other treatments and lifestyle improvements.

Some items on the FRAX score list of risk factors are manageable. You can lower your score and your risk right away by quitting cigarettes and cutting back on 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 general, a bone density test is recommended for women starting at age 65 and men at age 70. However, your doctor may suggest one earlier if you have a personal history of fractures or a family history of bone problems.

Once you have a BMD measurement, you can get a FRAX score. If it looks like your risk of an osteoporotic fracture is high in the next few years, talk with your doctor about medications, supplements, lifestyle changes, and anything else you can do to reduce your risk and protect yourself from a potentially life-altering fracture.