Special Position Paper

Osteoporosis International

, Volume 19, Issue 4, pp 429-435

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™)

  • S. FujiwaraAffiliated withDepartment of Clinical Studies, Radiation Effects Research Foundation Email author 
  • , T. NakamuraAffiliated withDepartment of Orthopedic Surgery, University of Occupational and Environmental Health
  • , H. OrimoAffiliated withJapan Osteoporosis Foundation
  • , T. HosoiAffiliated withDepartment of Advanced Medicine, National Center for Geriatrics and Gerontology
  • , I. GoraiAffiliated withDepartment of Obstetrics & Gerontology, International University of Health & Welfare, Atami Hospital
  • , A. OdenAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , H. JohanssonAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School
  • , J. A. KanisAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School



The present study estimated the 10-year probability using the Japanese version of WHO fracture risk assessment tool (FRAX™) in order to determine fracture probabilities that correspond to intervention thresholds currently used in Japan and to resolve some issues for its use in Japan.


The objective of the present study was to evaluate a Japanese version of the WHO fracture risk assessment (FRAX™) tool to compute 10-year probabilities of osteoporotic fracture in Japanese men and women. Since lumbar spine bone mineral density (BMD) is used preferentially as a site for assessment, and densitometers use Japanese reference data, a second aim was to investigate the suitability and impact of this practice in Japan.


Fracture probabilities were computed from published data on the fracture and death hazards in Japan. Probabilities took account of age, sex, the presence of clinical risk factors and femoral neck BMD. Fracture probabilities were determined that were equivalent to intervention thresholds currently used in Japan. The difference between T-scores derived from international reference data and that using Japanese-specific normal ranges was estimated from published sources. The gradient of risk of BMD for fracture in Japan was compared to that for BMD at the lumbar spine in the Hiroshima cohort.


The 10-year probabilities of a major osteoporosis-related fracture that corresponded to current intervention thresholds ranged from approximately 5% at the age of 50 years to more than 20% at the age of 80 years. The use of femoral neck BMD predicts fracture as well as or better than BMD tests at the lumbar spine. There were small differences in T-scores between those used for the model and those derived from a Japanese reference population.


The FRAX™ tool has been used to determine possible thresholds for therapeutic intervention, based on equivalence of risk with current guidelines. The approach will need to be supported by appropriate health economic analyses. Femoral neck BMD is suitable for the prediction of fracture risk among Japanese. However, when applying the FRAX™ model to Japan, T-scores and Z-scores should be converted to those derived from the international reference.


Bone mineral density Fracture Fracture probability Fracture risk assessment tool Intervention thresholds Japan