FRAX estimates a person’s 10-year probability of a major osteoporotic fracture and of a hip fracture, from age, sex, body size, clinical risk factors, and bone density when it’s known. See what each input means and how to read the result against treatment thresholds, then record it with the free template. Run the calculation itself on the official FRAX site.
FRAX result template
FreeFRAX RESULT Date: [Date] Patient: [Name or ID, age, sex] Reason: [Screening, after a bone density scan, glucocorticoid review, or after a fracture] Country model: [Country and population model used on the official calculator] RISK FACTORS ENTERED Age and sex: [Age in years; female or male] Weight and height: [Weight, height, and BMI] Prior fragility fracture: [Yes or no; site and year] Parent fractured hip: [Yes or no; which parent] Current smoking: [Yes or no; amount] Glucocorticoids: [Yes or no; drug, daily dose, and how long] Rheumatoid arthritis: [Yes or no; how it was confirmed] Secondary osteoporosis: [Yes or no; the condition] Alcohol 3 or more units a day: [Yes or no; usual intake] Femoral neck BMD: [T-score, or g/cm2 and scanner make; scan date; or not done] RESULTS Without BMD: [Major osteoporotic fracture %; hip fracture %] With BMD: [Major osteoporotic fracture %; hip fracture %] Adjustments: [Glucocorticoid dose, recent fracture, lumbar spine BMD, or none; adjusted values] Risk category: [Low, moderate, or high, and the thresholds the practice uses] CLINICAL PICTURE Other findings: [Lumbar spine T-score, vertebral imaging, falls in the past year, labs] Impression: [Fracture risk in a sentence, and what drives it] PLAN Treatment: [Start, continue, or no drug treatment; agent and dose] Bone health: [Calcium, vitamin D, exercise, smoking and alcohol, fall prevention] Follow-up: [When to repeat bone density and FRAX] Clinician: [Name, credentials]
Use it for
FRAX has a model for each country, built from that country’s fracture and death rates. Pick it first on the official calculator.
Avoid: Leaving the calculator on whichever country it opened with.
Twelve inputs: age, sex, weight, height, seven yes or no risk factors, and femoral neck bone density if you have it.
Avoid: Entering a former smoker as a smoker, or osteoarthritis as rheumatoid arthritis.
FRAX takes one bone density value: the femoral neck, as a T-score or as BMD in g/cm² with the scanner make.
Avoid: Entering the lowest T-score on the report, which is often the spine.
FRAX returns two percentages: the 10-year probability of a major osteoporotic fracture and of a hip fracture. Read both against your guideline’s thresholds.
Avoid: Treating FRAX as the decision. It gives the probability; the guideline and the conversation with the patient decide treatment.
The yes or no answers miss dose and timing. FRAXplus, on the official site, adjusts the result for some of them.
Avoid: Using a change in FRAX to judge whether treatment is working. It can be used in people recently on treatment, or when a change of drug is planned, but it isn’t a treatment target.
Each one follows the recording template. Use them to judge how much to write.
Family practice, going through a DXA report with the patient
66-year-old woman, 61 kg, 165 cm, BMI 22.4. Prior fragility fracture: no. Parent fractured hip: yes, her mother at 79. Current smoking: no. Glucocorticoids: no. Rheumatoid arthritis: no. Secondary osteoporosis: no. Alcohol 3 or more units a day: no. Femoral neck T-score −2.1 on the scan of November 3.
National model on the official calculator. Without BMD: major osteoporotic fracture 16.5%, hip 2.9%. With BMD: major osteoporotic fracture 20.6%, hip 3.9%. No adjustments. Risk category: high, with the major fracture probability at 20% or more and the hip probability at 3% or more.
Lumbar spine T-score −1.8. Menopause at 51, no hormone therapy. No falls in the past year; walks most days. Calcium, kidney function, and vitamin D normal last month. Impression: low bone mass with high fracture risk, driven by her hip density and her mother’s hip fracture.
Talked through a 1 in 5 chance of a major fracture in 10 years and the options. She chose alendronate 70 mg weekly, taken upright with water 30 minutes before breakfast; dental check is up to date. Calcium from food, vitamin D 1,000 IU daily, strength and balance exercise. Repeat DXA in 2 years; review whether to continue treatment at 5 years.
Rheumatology follow-up, polymyalgia rheumatica on long-term prednisone
58-year-old man, 84 kg, 178 cm, BMI 26.5. Prior fragility fracture: no. Parent fractured hip: no. Current smoking: yes, about 15 cigarettes a day. Glucocorticoids: yes, prednisone for 14 months, now 10 mg daily after two relapses on tapering. Rheumatoid arthritis: no. Secondary osteoporosis: no. Alcohol 3 or more units a day: no. Femoral neck T-score −1.8 on the scan of October 20.
National model on the official calculator. Without BMD: major osteoporotic fracture 9.4%, hip 1.5%. With BMD: major osteoporotic fracture 11.6%, hip 2.6%, moderate. Adjusted for prednisone above 7.5 mg a day: major osteoporotic fracture 13.3%, hip 3.1%. Risk category: high, on the adjusted hip fracture probability of 3% or more.
Lumbar spine T-score −1.5. No back pain or height loss, but a lateral spine X-ray is ordered to look for a silent vertebral fracture. No falls. Calcium and kidney function normal; vitamin D low. Impression: high fracture risk from long-term prednisone at more than 7.5 mg a day, with smoking adding to it.
Alendronate 70 mg weekly, started today. Vitamin D 2,000 IU daily, calcium from food. Methotrexate started to help taper prednisone. Smoking cessation support offered and accepted. Reassess fracture risk in 12 months while he stays on prednisone; repeat DXA in 2 years.
FRAX takes the femoral neck only. A spine or total hip T-score, or one from a local reference range, gives a misleading result.
Smoking means current smoking, and rheumatoid arthritis needs a confirmed diagnosis. A wrong yes to either raises the result.
FRAX gives a major fracture probability and a hip fracture probability, and some thresholds turn on the hip number. Record both, with and without BMD.
A fracture in the past 2 years, more than one fracture, high-dose glucocorticoids, and repeated falls push real risk above the number. Note them, and adjust where the official site allows.
Each country model gives a different number for the same patient. Record which one you used, so the next clinician can repeat it.
Vero Scribe records the FRAX result in your template from the visit, with the patient’s consent, or from your dictation: the inputs, the model, both probabilities, and the plan. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
It’s a person’s 10-year probability of a major osteoporotic fracture, meaning a clinical spine, hip, forearm, or upper arm fracture, and separately of a hip fracture. FRAX works it out from age, sex, weight, height, seven clinical risk factors, and femoral neck bone density when it’s known.
It depends on the guideline. Under 10% for a major fracture is low, 10% to 19.9% moderate, and 20% or more high. Some guidelines treat people with low bone mass at a major fracture probability of 20% or more or a hip fracture probability of 3% or more; others weigh the moderate band case by case or use thresholds that rise with age. A hip or vertebral fragility fracture usually means treatment whatever the score.
Yes. Leave the bone density field blank and FRAX uses body mass index instead. The result is less precise, and it’s often used to decide who needs a DXA scan. Once you have the femoral neck result, run it again with BMD.
A T-score compares bone density with young adults’ and says nothing else. FRAX combines the femoral neck T-score with age, sex, and clinical risk factors to give a probability of fracture, so two people with the same T-score can have very different FRAX results.
FRAX is meant for health care professionals. Anyone on the care team can enter the inputs, and the clinician reads the result against the guideline. The model accepts ages 40 to 90 and is used most in postmenopausal women and in men aged 50 and over.
Single FRAX calculations are free on the official site, fraxplus.org; the old University of Sheffield address now leads there. The adjustments, bulk calculation, and API access come with an account or subscription. The FRAX algorithm is proprietary, so this page explains and records the result rather than calculating it. The recording template here is free to copy or download.
No. FRAX was launched in 2008 by a team at the WHO Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield, but the WHO didn’t develop or endorse it. It’s now run by Osteoporosis Research Ltd.
Six nursing items that predict a patient’s risk of falling in hospital, scored 0 to 125: the higher the total, the higher the risk.
Stand, walk 3 meters, turn, walk back, and sit: a timed test of mobility and fall risk, with 12 seconds as the usual flag.
Fourteen balance tasks, from sitting to standing on one leg, scored 0 to 56: the higher the total, the better the balance.
A 9-level clinical judgment of frailty in older adults, from very fit to terminally ill, scored on the person’s state before an acute illness.
A scored frailty test across nine domains, with a clock drawing and a timed up and go, totaled 0 to 17 from not frail to severe frailty.
Falls aren’t a FRAX input: history, gait, medicines, and the prevention plan.
Notes for inflammatory arthritis and long-term glucocorticoid care.
Notes for osteoporosis, bone density reviews, and metabolic bone disease.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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