FRAX Calculator Guidelines

Primary Indications for FRAX Calculator Use

The American College of Radiology recommends using FRAX to calculate 10-year probability of hip fracture or major osteoporotic fracture in patients with risk factors for fracture 1
FRAX is particularly valuable in patients with osteopenia to determine if pharmacologic treatment is warranted, according to the Journal of the American College of Radiology 2
For adults ≥40 years initiating glucocorticoid therapy, FRAX with glucocorticoid dose adjustment should be used within 6 months of starting treatment, as recommended by Arthritis and Rheumatology 3, 4

For postmenopausal women and men over 50 years with low bone mass but not osteoporosis, FRAX helps identify those who would benefit from treatment, according to the Journal of the American College of Radiology 2
In patients on glucocorticoids, FRAX should be used with dose adjustment, increasing major osteoporotic fracture risk by 1.15 and hip fracture risk by 1.2 if prednisone dose >7.5 mg/day, as recommended by Arthritis and Rheumatology 3, 5
FRAX should be used when DXA results alone may not capture full fracture risk, especially in younger populations, according to JAMA 1, 6

For adults ≥40 years on continued glucocorticoid treatment who are not on osteoporosis medication, FRAX reassessment should be completed every 1-3 years, as recommended by Arthritis care & research 5, 7
Earlier reassessment within this timeframe is recommended for patients on very high-dose glucocorticoids, according to Arthritis care & research 5, 7
For patients with history of osteoporotic fracture, reassessment should be performed more frequently, as recommended by Arthritis care & research and Arthritis and Rheumatology 5, 8

According to National Osteoporosis Foundation guidelines, treatment is recommended for patients with FRAX 10-year risk scores of ≥3% for hip fracture or ≥20% for major osteoporotic fracture 2
FRAX results should guide the decision to initiate bone mineral density testing and/or osteoporosis treatment, according to JAMA 1
In patients with low bone mass, FRAX helps identify the subset at higher fracture risk who would benefit from pharmacologic intervention, according to the Journal of the American College of Radiology 2

The calculator has limitations regarding race-specific calculations, which may lead to differences in treatment recommendations among persons with otherwise identical risk profiles, according to JAMA 1, 6
FRAX does not account for dose-dependent effects of risk factors like glucocorticoids and alcohol, according to JAMA 1, 6
The predictive accuracy of FRAX improves when BMD is included in the risk assessment calculation, according to JAMA 1, 6

FRAX should be used alongside clinical fracture risk assessment, which includes evaluation of falls, fractures, frailty, and other risk factors, as recommended by Arthritis and Rheumatology 3, 8
When available, including BMD measurements from DXA improves the accuracy of FRAX predictions, according to JAMA 1, 6
For patients <40 years of age, FRAX is not validated, and clinical risk assessment with BMD testing should be used instead, as recommended by Arthritis and Rheumatology 3, 4