Position Paper

Osteoporosis International

, 22:2395

First online:

Interpretation and use of FRAX in clinical practice

  • J. A. KanisAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School Email author 
  • , D. HansAffiliated withCenter of Bone Diseases, Bone and Joint Department, Lausanne University Hospital
  • , C. CooperAffiliated withMRC Lifecourse Epidemiology Unit, University of SouthamptonNIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford
  • , S. BaimAffiliated withDivision of Endocrinology, University of Miami, Miller School of Medicine
  • , J. P. BilezikianAffiliated withColumbia University College of Physicians and Surgeons
  • , N. BinkleyAffiliated withOsteoporosis Clinical Research Program, University of Wisconsin
  • , J. A. CauleyAffiliated withDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh
  • , J. E. CompstonAffiliated withDepartment of Medicine, Addenbrooke’s Hospital, Cambridge University
  • , B. Dawson-HughesAffiliated withJean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University
    • , G. El-Hajj FuleihanAffiliated withWHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut
    • , H. JohanssonAffiliated withCentre for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg
    • , W. D. LeslieAffiliated withUniversity of Manitoba
    • , E. M. LewieckiAffiliated withNew Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine
    • , M. LuckeyAffiliated withSt. Barnabas Osteoporosis & Metabolic Bone Disease Center
    • , A. OdenAffiliated withCentre for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg
    • , S. E. PapapoulosAffiliated withDepartment of Endocrinology and Metabolic Diseases, Leiden University Medical Center
    • , C. PoianaAffiliated withDepartment of Endocrinology, Carol Davila University of Medicine and Pharmacy
    • , R. RizzoliAffiliated withDivision of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine
    • , D. A. WahlAffiliated withInternational Osteoporosis Foundation
    • , E. V. McCloskeyAffiliated withAcademic Unit of Bone Metabolism, University of Sheffield
    • , Task Force of the FRAX Initiative

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The introduction of the WHO FRAX® algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. Its use in fracture risk prediction has strengths, but also limitations of which the clinician should be aware and are the focus of this review


The International Osteoporosis Foundation (IOF) and the International Society for Clinical Densitometry (ISCD) appointed a joint Task Force to develop resource documents in order to make recommendations on how to improve FRAX and better inform clinicians who use FRAX. The Task Force met in November 2010 for 3 days to discuss these topics which form the focus of this review.


This study reviews the resource documents and joint position statements of ISCD and IOF.


Details on the clinical risk factors currently used in FRAX are provided, and the reasons for the exclusion of others are provided. Recommendations are made for the development of surrogate models where country-specific FRAX models are not available.


The wish list of clinicians for the modulation of FRAX is large, but in many instances, these wishes cannot presently be fulfilled; however, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice.


Bone mineral density Clinical risk factors Fracture probability Risk assessment