Fracture Risk
Awareness Checklist
Review the same risk factors used by the FRAX tool to understand your fracture risk profile — with a direct link to the official calculator.
FRAX (Fracture Risk Assessment Tool) uses these 9 factors to calculate a 10-year fracture probability. This checklist helps you understand which apply to you — for an actual calculated percentage, use the official tool linked below.
| Factor | Why It Matters |
|---|---|
| Age & Sex | Fracture risk rises with age; patterns differ between men and women |
| Height & Weight | Used to calculate BMI, itself an independent risk factor |
| Prior fragility fracture | One of the strongest predictors of future fracture |
| Parental hip fracture | Reflects genetic/familial bone fragility patterns |
| Current smoking | Associated with lower bone density and impaired healing |
| Glucocorticoid use | Long-term steroid use is a well-documented cause of bone loss |
| Rheumatoid arthritis | Both the condition and its treatments affect bone density |
| Secondary osteoporosis | Underlying conditions that independently cause bone loss |
| Alcohol (3+ units/day) | Heavy alcohol use is associated with increased fracture risk |
Femoral neck BMD (bone density from a DXA scan) is an optional 10th input that refines FRAX accuracy when available.
What Is FRAX and Why This Isn't a Replica
We're being direct about something important: the actual FRAX algorithm is proprietary and country-specific, derived from studying approximately 230,000 individuals across multiple international population cohorts. It is not publicly published in a form that can be accurately replicated by a third-party calculator. Rather than approximating a number that could be misleadingly imprecise, this tool reviews the same 9 clinical risk factors FRAX uses, helping you understand your risk profile conceptually — and then directs you to the official FRAX calculator for an actual calculated percentage.
Why Prior Fracture Is Such a Strong Predictor
Among all the factors FRAX considers, a prior fragility fracture (a fracture occurring from a fall from standing height or less, or with minimal trauma) is one of the single strongest predictors of future fracture risk. This makes clinical sense: a fragility fracture is direct evidence that bone strength has already fallen below the threshold needed to withstand normal, everyday stresses — a genuinely different situation from theoretical risk based on age or other indirect factors alone. This is exactly why anyone with a prior fragility fracture, regardless of their other risk factors, is generally considered a priority for further bone health evaluation.
Understanding Secondary Osteoporosis
🦴 Primary Osteoporosis
Age-related and, particularly in women, related to declining estrogen after menopause — the most common form, driven by normal aging processes.
⚕️ Secondary Osteoporosis
Caused by an identifiable underlying condition or treatment — including type 1 diabetes, chronic liver disease, hypogonadism, inflammatory bowel disease, and several other conditions — that independently accelerates bone loss beyond typical age-related patterns.
Identifying whether a secondary cause is present matters clinically, since addressing or managing the underlying condition (where possible) can meaningfully change the overall fracture risk trajectory, beyond what general bone-health measures alone would achieve.
The BMD Question: Why It's Optional, Not Required
FRAX can be calculated with clinical risk factors alone, or with the addition of femoral neck bone mineral density (BMD) from a DXA scan, which refines the estimate's precision. This flexibility is a deliberate design feature — FRAX was specifically built to be useful in primary care settings where DXA scanning isn't always immediately accessible, allowing clinicians to get a meaningful initial risk estimate using only readily available clinical information, then add BMD data later if a scan is obtained. This is part of why FRAX has achieved such broad international adoption compared to bone-density-only assessment approaches.
How FRAX Is Used in the UK and Internationally
FRAX was originally developed at the University of Sheffield in the UK, and NHS clinical practice, guided by NICE and the National Osteoporosis Guideline Group (NOGG), uses FRAX extensively as a core tool for deciding who needs bone density scanning and who may benefit from treatment — the UK arguably has the deepest, most established clinical integration of FRAX of any country, given its origin there. NOGG has developed UK-specific guidance thresholds that translate a person's calculated FRAX percentage into a practical treatment recommendation (treat, consider BMD testing, or reassure with lifestyle advice), which is a genuinely useful downstream application beyond the raw percentage alone. Since FRAX is calibrated separately for each country's population fracture and mortality data, a US-calibrated FRAX calculation and a UK-calibrated one for someone with identical risk factors can produce somewhat different percentages — always select the correct country-specific version on the official tool for your situation.
What Happens After You Get a FRAX Score
A calculated FRAX percentage isn't an endpoint in itself — it's specifically designed to inform a treatment or further-testing decision. Different countries and guideline bodies set different intervention thresholds (the percentage above which treatment or further testing is generally recommended), which is part of why the same FRAX score might lead to different next steps depending on where you live and which guideline your doctor follows. Common next steps after a FRAX assessment include: no further action needed (low risk), a DXA bone density scan to refine the estimate (intermediate risk), or discussion of osteoporosis medication (high risk) — your doctor is best positioned to interpret your specific result within your country's guideline framework, which is exactly why this checklist deliberately stops short of generating a number and instead points you toward that official, properly calibrated assessment.
Supporting Bone Health Alongside Risk Awareness
Understanding your risk factors is most useful paired with the modifiable factors genuinely within your control. Adequate calcium and Vitamin D intake support bone health directly; see our Calcium + Vitamin D Deficiency Calculator. Regular weight-bearing exercise is another genuinely modifiable factor supporting bone density over time. If menopause timing is relevant to your risk profile, our Menopause Stage Estimator provides related context, since declining estrogen is a significant contributor to age-related bone loss in women.
Frequently Asked Questions
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