A decade of FRAX: how has it changed the management of osteoporosis?

Abstract

The fracture risk assessment tool, FRAX®, was released in 2008 and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Since its release, 71 models have been made available for 66 countries covering more than 80% of the world population. The website receives approximately 3 million visits annually. Following independent validation, FRAX has been incorporated into more than 80 guidelines worldwide. The application of FRAX in assessment guidelines has been heterogeneous with the adoption of several different approaches in setting intervention thresholds. Whereas most guidelines adopt a case-finding strategy, the case for FRAX-based community screening in the elderly is increasing. The relationship between FRAX and efficacy of intervention has been explored and is expected to influence treatment guidelines in the future.

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Fig. 1

Redrawn from [37] with kind permission from Springer Science and Business Media

Fig. 2

From [39], with kind permission from Springer Science and Business Media

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[figure redrawn from 58]

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Correspondence to John A. Kanis.

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Professor Kanis led the team that developed FRAX as director of the WHO Collaborating Centre for Metabolic Bone Diseases; he has no financial interest in FRAX. Professors McCloskey, Lorentzon, Harvey, Dr Liu, and Dr Johansson are members of the FRAX team. Professors Kanis, Harvey, and McCloskey are members of the advisory body to the National Osteoporosis Guideline Group.

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Kanis, J.A., Harvey, N.C., Johansson, H. et al. A decade of FRAX: how has it changed the management of osteoporosis?. Aging Clin Exp Res 32, 187–196 (2020). https://doi.org/10.1007/s40520-019-01432-y

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Keywords

  • FRAX
  • Fracture probability
  • Clinical risk factors
  • Intervention thresholds
  • Risk assessment
  • Screening