Osteoporosis International

, 22:2395

Interpretation and use of FRAX in clinical practice


    • WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical School
  • D. Hans
    • Center of Bone Diseases, Bone and Joint DepartmentLausanne University Hospital
  • C. Cooper
    • MRC Lifecourse Epidemiology UnitUniversity of Southampton
    • NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal SciencesUniversity of Oxford
  • S. Baim
    • Division of EndocrinologyUniversity of Miami, Miller School of Medicine
  • J. P. Bilezikian
    • Columbia University College of Physicians and Surgeons
  • N. Binkley
    • Osteoporosis Clinical Research ProgramUniversity of Wisconsin
  • J. A. Cauley
    • Department of Epidemiology, Graduate School of Public HealthUniversity of Pittsburgh
  • J. E. Compston
    • Department of Medicine, Addenbrooke’s HospitalCambridge University
  • B. Dawson-Hughes
    • Jean Mayer United States Department of Agriculture Human Nutrition Research Center on AgingTufts University
  • G. El-Hajj Fuleihan
    • WHO Collaborating Center for Metabolic Bone DisordersAmerican University of Beirut
  • H. Johansson
    • Centre for Bone Research at the Sahlgrenska Academy, Institute of MedicineUniversity of Gothenburg
  • W. D. Leslie
    • University of Manitoba
  • E. M. Lewiecki
    • New Mexico Clinical Research & Osteoporosis CenterUniversity of New Mexico School of Medicine
  • M. Luckey
    • St. Barnabas Osteoporosis & Metabolic Bone Disease Center
  • A. Oden
    • Centre for Bone Research at the Sahlgrenska Academy, Institute of MedicineUniversity of Gothenburg
  • S. E. Papapoulos
    • Department of Endocrinology and Metabolic DiseasesLeiden University Medical Center
  • C. Poiana
    • Department of EndocrinologyCarol Davila University of Medicine and Pharmacy
  • R. Rizzoli
    • Division of Bone Diseases, Department of Rehabilitation and GeriatricsGeneva University Hospitals and Faculty of Medicine
  • D. A. Wahl
    • International Osteoporosis Foundation
  • E. V. McCloskey
    • Academic Unit of Bone MetabolismUniversity of Sheffield
  • Task Force of the FRAX Initiative
Position Paper

DOI: 10.1007/s00198-011-1713-z

Cite this article as:
Kanis, J.A., Hans, D., Cooper, C. et al. Osteoporos Int (2011) 22: 2395. doi:10.1007/s00198-011-1713-z



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 densityClinical risk factorsFracture probabilityRisk assessment

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011