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A FRAX score indicates the risk of a fracture in a person with osteoporosis. Doctors can use it to determine the best measures to prevent fractures and treat the condition.

In this article, we look at what a FRAX score is, the results, and when to see a doctor.

a doctor discussing a frax score with a patientShare on Pinterest
A FRAX score can help doctors identify people with a high risk of fractures.

FRAX stands for Fracture Risk Assessment Tool. A research group at the University of Sheffield developed the tool to predict the risk of fractures in a person with osteoporosis within the next 10 years. It has now become widespread as a clinical tool.

According to the Osteoporosis and Related Bone Diseases National Resource Center, osteoporosis is very common, with roughly 53 million people in the United States living with the condition. It is more prevalent in older adults and people who have been through menopause.

According to the Preventive Services Task Force, if a female is 65 years of age or older or is postmenopausal before the age of 65 years, she should undergo a bone mineral density (BMD) test.

Doctors will compare the results with those of a healthy young adult and give the person a T-score. If a person receives a T-score between –1.0 and –2.5, a FRAX score can help doctors determine which treatment may be best.

Osteoporosis causes the breakdown of bone mass and tissue. By weakening the bones, osteoporosis increases the risk of fractures. A FRAX score can help doctors identify people with a high risk of fractures who may need additional support.

The tool consists of questions relating to 12 factors that can increase the risk of fractures.

These factors are:

  • age
  • weight
  • height
  • sex
  • smoking
  • history of fractures
  • parental history of fractures
  • presence of rheumatoid arthritis
  • use of glucocorticoid medications
  • having secondary osteoporosis
  • drinking three or more units of alcohol per day
  • bone mineral density

The responses to these questions will give a total risk score.

A FRAX score estimates the probability of a fracture within the next 10 years.

The output is a percentage, and higher values indicate a greater risk of fracture.

The score refers to fractures in the:

  • hip
  • arm
  • spine

These are common areas for fractures to occur in people with osteoporosis. The FRAX score can then be useful for determining whether someone needs treatment or further testing.

If a person has a high FRAX score, they may need treatment for osteoporosis. These treatment options include:

Lifestyle changes

Some FRAX scores indicate that lifestyle changes should be sufficient to manage the risk of fractures.

These changes might include:

  • stopping smoking
  • reducing alcohol intake
  • keeping physically active
  • getting enough calcium and vitamin D
  • eating a healthful diet
  • limiting the use of some long-term medications, such as glucocorticoids, whenever possible

Calcium and vitamin D supplements may be necessary.

Calcium is a mineral that is essential for keeping bones healthy. People generally need 200–1,300 milligrams of calcium per day, depending on their age.

About 600–800 international units of vitamin D are necessary for most people.

A person can buy calcium supplements here and vitamin D supplements here.

Preventing falls

Falls account for nearly 90% of fractures in people with osteoporosis. Reducing the risk of falls — which is likely to involve some changes to the environment — may help prevent fractures.

Examples of ways to prevent falls include:

  • removing any obstacles around the home
  • keeping the home tidy
  • wearing supportive shoes with a good grip
  • avoiding heavy lifting
  • using a rubber mat in the bath or shower and on the floor of the bathroom
  • avoiding having rugs on hard flooring, as they might shift underfoot
  • having handlebars on either side of the bath, shower, and toilet
  • avoiding keeping floors and surfaces too polished
  • switching to a cordless phone
  • using a cane while walking
  • avoiding slippery sidewalks whenever possible
  • walking around the home in shoes or barefoot, rather than in socks, stockings, or slippers

Medication

A high FRAX score indicates that the person might need medical treatment in addition to making these lifestyle changes.

Many medications are available to treat osteoporosis. These may include:

  • Bisphosphonates: Medications belonging to this class help prevent bone loss and reduce the risk of fractures.
  • Estrogen agonists or antagonists: These can decrease bone resorption, and doctors typically recommend them for people at higher risk of a spine fracture.
  • Parathyroid hormone analogs: These can help stimulate new bone formation on the surface of the bone.

The signs of osteoporosis are not always obvious. The condition can cause bone density to decrease without producing any symptoms. As the symptoms of osteoporosis are rarely present in its early stages, detecting the condition is difficult.

A person should see a doctor and get a BMD test if they:

  • are female and over the age of 65 years
  • are male and over the age of 70 years
  • break a bone after the age of 50 years
  • are female and going through the menopause

A person should also receive a BMD test if:

  • an X-ray shows that they have a break or signs of bone loss in the spine
  • they lose 0.5 inches (in) off their height in 1 year
  • they lose 1.5 in off their original height
  • they experience back pain

FRAX is a clinical tool for assessing the risk of fractures in people with osteoporosis. The FRAX score can help doctors identify people who might need additional support.

People with a high FRAX score have a higher risk of fractures. A doctor may suggest certain lifestyle changes or medications.

Falls account for most fractures in people with osteoporosis. Preventing falls is, therefore, very important in reducing the risk of fractures.