Your estimated 10-year fracture risk is presented as two probabilities: one for any major osteoporotic fracture (hip, spine, forearm, or proximal humerus) and one for hip fracture alone. According to the National Osteoporosis Foundation (NOF) guidelines, pharmacologic treatment is generally recommended when the 10-year probability of a major osteoporotic fracture is 20% or greater, or when the 10-year probability of hip fracture is 3% or greater, in patients with low bone mass (T-score between -1.0 and -2.5).

A result below these thresholds does not mean fractures will not occur — it indicates that the absolute risk over 10 years is lower and that lifestyle interventions (calcium, vitamin D, weight-bearing exercise, fall prevention) may be sufficient. Your provider will integrate this result with bone mineral density testing and your overall clinical picture.

Use this tool for postmenopausal women and men aged 50 and older who have low bone mass (osteopenia, T-score between -1.0 and -2.5) but do not yet meet the diagnostic threshold for osteoporosis. It helps guide the decision about whether to initiate pharmacologic therapy with bisphosphonates or other osteoporosis medications.

FRAX is not needed when the decision to treat is already clear — for example, patients with a prior hip or vertebral fracture, or those with T-scores at or below -2.5, should generally receive treatment regardless of FRAX results. The tool is most valuable for borderline cases where the clinical benefit of treatment is uncertain.

This is a simplified approximation of the WHO FRAX algorithm and does not incorporate bone mineral density (BMD) measurements or country-specific fracture and mortality data. For official, validated results, the WHO FRAX tool at sheffield.ac.uk/FRAX should be used, particularly for clinical decision-making.

FRAX has several known limitations even in its official form. It uses dichotomous (yes/no) risk factors and does not account for dose-response relationships — for example, it does not differentiate between one and ten prior fractures, or between low-dose and high-dose glucocorticoid use. It also does not include fall history, which is a major independent risk factor for fractures. FRAX underestimates risk in patients with lumbar spine BMD significantly lower than femoral neck BMD, and it does not account for trabecular bone score or vertebral fractures found incidentally on imaging.