Osteoporosis International

, Volume 21, Issue 3, pp 381–389

FRAX® assessment of osteoporotic fracture probability in Switzerland

  • K. Lippuner
  • H. Johansson
  • J. A. Kanis
  • R. Rizzoli
Original Article

DOI: 10.1007/s00198-009-0975-1

Cite this article as:
Lippuner, K., Johansson, H., Kanis, J.A. et al. Osteoporos Int (2010) 21: 381. doi:10.1007/s00198-009-0975-1



A Swiss-specific FRAX® model was developed. Patient profiles at increased probability of fracture beyond currently accepted reimbursement thresholds for bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA), and osteoporosis treatment were identified.


This study aimed to determine which constellations of clinical risk factors, alone, or combined with BMD measurement by DXA, contribute to improved identification of Swiss patients with increased probability of fracture.


The 10-year probability of hip and any major osteoporotic fracture was computed for both sexes, based on Swiss epidemiological data, integrating fracture risk and death hazard, in relation to validated clinical risk factors, with and without BMD values.


Fracture probability increased with age, lower body mass index (BMI), decreasing BMD T-score, and all clinical risk factors used alone or combined. Several constellations of risk factor profiles were identified, indicating identical or higher absolute fracture probability than risk factors currently accepted for DXA reimbursement in Switzerland. With identical sex, age and BMI, subjects with parental history of hip fracture had as high a probability of any major osteoporotic fracture as patients on oral glucocorticoids or with a prevalent fragility fracture. The presence of additional risk factors further increased fracture probability.


The customised FRAX® model indicates that a shift from the current DXA-based intervention paradigm, toward a fracture risk continuum based on the 10-year probability of any major osteoporotic fracture may improve identification of patients at increased fracture risk.


Clinical risk factorsFRAX®Hip fractureOsteoporotic fracture10-year fracture probability

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • K. Lippuner
    • 1
  • H. Johansson
    • 2
  • J. A. Kanis
    • 2
  • R. Rizzoli
    • 3
  1. 1.Osteoporosis PoliclinicInselspital, Bern University Hospital and University of BernBernSwitzerland
  2. 2.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  3. 3.Division of Bone Diseases, WHO Collaborating Centre for Osteoporosis Prevention, Department of Rehabilitation and GeriatricsUniversity Hospital and Medical Faculty of GenevaGenevaSwitzerland
  4. 4.University Hospital and University of BernBernSwitzerland