Each one, though, represents an important osteoporosis risk factor. Rheumatoid arthritis No Yes 10. Follow this link for information on the tool:http://www.garvan.org.au/bone-fracture-risk/, Osteoporosis, New Zealand, Do you have a question about how theFracture Risk Calculatorworks for you?Find answers on theCalculator Frequently Asked Questions (FAQs) page. Still, it is often overlooked and undertreated, in large part . note: This review updates a previous article on this topic by Sweet, Sweet, Jeremiah, and Galazka.29. Men are also more likely to fracture a bone as they age. The impact of fractures includes loss of function, significant costs, and increased mortality. Your FRAX score is your risk of having an osteoporosis-related fracture in the next. Egton Medical Information Systems Limited. Usually these hormone-related therapies accompany other treatments and lifestyle improvements. Otherwise enter no (see also notes on risk factors). They are considered first-line pharmacologic therapy. Dr. John A Kanis Professor Emeritus, University of Sheffield It is a useful tool to aid clinical decision making about the use of pharmacologic therapies in patients with low bone mass. CHADS-VASc Score for Atrial Fibrillation Stroke Risk Calculates stroke risk for patients with atrial fibrillation, possibly better than the CHADS Score. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the U.S. Army Medical Corps, or the U.S. Army at large. Patient is a UK registered trade mark. Yes No T-scores ? Disability (pain, disability, complications), Excessive alcohol intake (> 4 drinks per day for men; > 2 drinks per day for women), caffeine intake (> 2.5 units [e.g., cups of coffee] per day), and tobacco use (any smoking), Spinal or hip BMD within 1.0 SD below the young adult female reference mean (T-score 1.0), Spinal or hip BMD between 1.0 and 2.5 SDs below the young adult female reference mean (T-score < 1.0 and > 2.5), Spinal or hip BMD 2.5 SDs below the young adult female reference mean (T-score 2.5), BMD 2.5 SDs below the young adult female reference mean and the presence of one or more fragility fractures, American Association of Clinical Endocrinologists, With a history of fracture(s) without major trauma after 40 to 45 years of age, With osteopenia identified radiographically, Starting or taking long-term systemic glucocorticoid therapy ( 3 months), Patients at increased risk of secondary osteoporosis (e.g., rheumatoid arthritis). 2005 - 2023 WebMD LLC. - http://www.garvan.org.au/bone-fracture-risk Garvan - This Fracture Risk Calculator was developed using data collected in the internationally renowned Dubbo Osteoporosis Epidemiology Study conducted by the Bone and Mineral Research Program of Sydney's Garvan Institute of Medical Research. The National Osteoporosis Foundation recommends treatment of postmenopausal women and men with a personal history of hip or vertebral fracture, a T-score of 2.5 or less, or a combination of low. Alternatively, enter the T-score based on the NHANES III female reference data. Randomized clinical trials demonstrate a reduction of vertebral and hip fractures with alendronate (Fosamax) and risedronate (Actonel).16,26 Alendronate and risedronate also decrease vertebral fractures in men30,31 and in patients with glucocorticoid-induced osteoporosis.32,33 Daily and intermittent use of ibandronate (Boniva) have demonstrated effectiveness in reducing fractures of the spine only.34 Weekly and monthly dosing formulations improve adherence.35 Oral bisphosphonates should be taken only with water and a wait of at least 30 minutes before reclining or ingesting other medication or food. During the test, you lie down and a scanner passes over your body. Genetics is one of the most important factors that determine your risk of fractures. the tool is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck it gives the 10 year probability of a fracture - hip fracture and of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) It usually develops unnoticed over many years until you have a fracture. The need for follow-up bone mineral density testing in patients receiving treatment for osteoporosis is uncertain. Other drugs may be used, such as denosumab (Prolia) or zoledronic (Reclast), which are given by injection. Osteoporosis in men younger than 50 years cannot be diagnosed based on BMD assessment alone.7, Published osteoporosis screening guidelines vary greatly (eTable A). Resistance training is one of the best things you can do to manage osteoporosis. In their most sophisticated form, the FRAX tool is computer-driven and is available on this site. Male Female Age Fractures since the age of 50 (excluding major trauma, e.g. Please visit our website Medicalalgorithms.com for Description and Interpretation and further algorithms you may want to consider in the next steps of your evaluation. 24/7 Live Expert. A recent survey by EB Medicine has shown that MDCalc's . Other perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions: Excessive consumption of alcohol (> 2 drinks per day for women), Low body weight (< 58 kg [128 lb] or body mass index < 20 kg per m, Any history of long-term systemic glucocorticoid therapy ( 3 months), American College of Obstetricians and Gynecologists, Bone density screening no more than once every two years beginning at 65 years of age, unless new health risks develop, Selective screening in women younger than 65 years if they are postmenopausal and have other osteoporosis risk factors or fracture, In the absence of new risk factors, DEXA monitoring of therapy should not be repeated after BMD is determined to be stable or improved, In women 65 years and older and in men 70 years and older, In postmenopausal women and men 50 to 69 years of age; recommended based on risk factor profile, With vertebral imaging in those who have had a fracture to determine degree of disease severity, At DEXA facilities using accepted quality assurance measures, In women 65 years and older and in men 70 years and older to diagnose vertebral fractures if T-score is 1.5, In women 70 years and older and in men 80 years and older to diagnose vertebral fractures, regardless of T-score, In postmenopausal women and men 50 years and older with a low-trauma fracture, In postmenopausal women and men 50 to 69 years of age to diagnose vertebral fractures if there is height loss 4 cm (1.5 in), or recent or ongoing long-term glucocorticoid therapy, To check for causes of secondary osteoporosis, BMD testing one to two years after initiating therapy to reduce fracture risk and every two years thereafter, More frequent testing in certain clinical situations, Longer interval between repeat BMD tests for patients without major risk factors and who have an initial T-score in the normal or upper lowbone mass range, Risk factors: glucocorticoid use (> 3 months cumulative therapy in past year), high-risk medication use, hypogonadism or premature menopause (age < 45 years), malabsorption syndrome, hyperparathyroidism, other associated disorders, Low body weight (< 60 kg [132 lb]) or weight loss (> 10% of weight at 25 years of age), Vertebral fracture or osteopenia on radiography, Repeat BMD testing in one to three years and reassess risk in moderate- and high-risk groups, United Kingdom National Osteoporosis Guideline Group, Case finding for BMD assessment is based on risk factor assessment and comparison of risk to age- and sex-specific fracture probabilities, Screen for osteoporosis in women 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors, Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men, Central nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke), Endocrine/metabolic disorders (adrenal insufficiency, athletic amenorrhea, Cushing syndrome, hemochromatosis, homocystinuria, primary hyperparathyroidism, hyperprolactinemia, hyperthyroidism, primary or secondary hypogonadism, premature menopause, thyrotoxicosis, type 1 diabetes mellitus), Gastrointestinal disorders (celiac disease, gastric bypass, inflammatory bowel disease, malabsorption, pancreatic insufficiency, primary biliary cirrhosis), Hematologic disorders (hemophilia, leukemia and lymphomas, monoclonal gammopathies, multiple myeloma, sickle cell disease, thalassemia), Human immunodeficiency virus infection or AIDS, Nutrition disorders (alcoholism, anorexia nervosa/bulimia, malnutrition, vitamin A excess, vitamin D deficiency), Anticonvulsants (e.g., phenobarbital, phenytoin [Dilantin]), Gonadotropin-releasing hormone agonists and antagonists, Thiazolidinediones (e.g., pioglitazone [Actos]), 4 drinks per day for men or 2 drinks per day for women, 2.5 cups of coffee or 5 cups of tea per day, Multicomponent exercise with strength and balance training, Consider drug discontinuation after 5 years in low-risk patients, Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw, Alendronate/cholecalciferol (Fosamax Plus D), Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy. However, the addition of ethnic databases may not fully distinguish the variability of racial, ethnic, and national origins of the Hispanic community in the Unites States. Osteoporosis, in which low bone mass and micro-structural deterioration of bone tissue lead to increased bone fragility, is the most common metabolic bone disease in the United States. Have you broken bones with little impact, such as a trip or fall from level ground, since age 45? Or very high doses of inhaled steroids for extended periods of time? The fun challenges, personalized instruction, and motivating rewards help students build their skills and understanding - all while exploring the galaxy with fractions! Once you have a BMD measurement, you can get a FRAX score. Calculation assumes no other risk factors for Osteoporosis. Height must be between 4 feet 8 inches and 6 feet 4 inches. For details see our conditions. Low risk - QRISK2 score of less than 10% This means that you have less than a one in ten chance of having a stroke or heart attack in the next 10 years. Find out what it means, how it's calculated. The U.S. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older, and younger women who have an increased fracture risk as determined by the FRAX Fracture Risk Assessment Tool. However, your doctor may suggest one earlier if you have a personal history of fractures or a family history of bone problems. You can use this calculator to work out your risk of developing any osteoporotic (i.e. If no medical conditions, click next. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Welcome to the QRISK 3-2018 Web Calculator. This osteoporosis risk score calculator stratifies osteoporosis risk, especially useful in women with low bone density. By checking this box, you are confirming that you live in the US and you are opting in to receive your Fracture Risk Calculator results and information about managing bone health via email. Enter yes where the patient has a confirmed diagnosis of rheumatoid arthritis. Now there is a Fracture Risk Assessment Tool (FRAX ) for evaluating fracture risk. Its a painless, non-invasive scan that measures bone strength in your hip and spine. Inflammation around the joints causes bone loss; pain leads to reduced activity.Enter "Yes" if you have Rheumatoid Arthritis. A FRAX score can give you a better idea of your risk. 2005-2023 Healthline Media a Red Ventures Company. Find out more: The Effects of a FRAX Revision for the USA, The Potential Impact of New NOF Guidance on Treatment Patterns, Updated Fracture Incidence Rates for the US Version of FRAX, Copyright 2023 Bone Health & Osteoporosis Foundation. Knowing your 10-year risk for fractures will allow you and your doctor to make decisions about treatment. Consuming more than 2.5 units of caffeine daily (1 unit = one cup of coffee or two cups of tea) may increase fracture risk.24 Diets with adequate protein intake are necessary for optimal bone health, but the proper amount or source (plant vs. animal) remains controversial. If you do not know your Femoral Neck T-score, leave this field blank and click next. A doctor told you or it was reported on an x-ray? A fall risk assessment should be performed and a multicomponent exercise program and smoking cessation should be recommended to decrease fracture risk in individuals 65 years and older with osteoporosis or a history of vertebral fracture. How Does Resistance Training Prevent Osteoporosis. A unit of alcohol varies slightly in different countries from 8-10g of alcohol. Let's look at why and your. Enter yes if the patient takes 3 or more units of alcohol daily. All rights reserved. Secondary osteoporosis is caused by other health conditions (Table 4).2 Up to 30% of osteoporosis cases in postmenopausal women are estimated to be from a secondary cause.10 The estimate climbs to greater than 50% in men, premenopausal women, and perimenopausal women if vitamin D deficiency is included as a secondary cause.1113 In addition to performing a history and physical examination, expert consensus suggests a basic laboratory evaluation for all newly diagnosed patients to determine if there are contraindications for certain osteoporosis medications and to identify the more common secondary causes. The Women's Health Initiative study confirmed that estrogen, with or without progesterone, slightly reduced the risk of hip and vertebral fractures; however, this benefit did not outweigh the increased risk of stroke, venous thromboembolism, coronary heart disease, and breast cancer, even for women at high risk of fracture.46 Lower doses of conjugated equine estrogens and estradiol have been shown to improve BMD, but a reduced risk of fracture has not been demonstrated and the safety is unknown.47. Enter weight in whole pounds, rounding to the nearest pound. A "unit" in the UK is 8 g ethanol. Your doctor may recommend treatment to reduce your fracture risk. This may be asking you to have a bone scan, or talking to you about measures that can help prevent osteoporosis. Author disclosure: No relevant financial affiliations. First-line treatment to prevent fractures consists of fall prevention, smoking cessation, moderation of alcohol intake, and bisphosphonate therapy. There is a direct relationship between tobacco and decreased bone density, whether its the smoking or the other risk factors of smokers, such as, being thinner, drinking more alcohol, being less physically active, and having a poor diet. In addition to femoral neck (hip) BMD, age, gender, fracture history and steroid use, FRAX also takes into account other clinical risk factors to calculate the absolute 10-year risk of a hip fracture or other major osteoporotic fracture (spine, forearm, upper arm). Had multiple osteoporosis-related fractures. A "standard drink" in the USA is 14 g. The FRAX asks for 3 or more units = 24 g, which is slightly less than 2 US drinks/day (28g). Shown to have greater variability in agreement when scored by medical and radiation oncologists, to whom these patients are most likely to present. FRAX is a sophisticated risk assessment instrument, developed by the University of Sheffield. In a dose of 60 mg given subcutaneously every six months for three years, it significantly increased BMD in postmenopausal women compared with weekly dosing of alendronate.44 Denosumab has been shown to decrease hip, vertebral, and nonvertebral fractures compared with low doses of calcium and vitamin D. It appears to be a reasonable alternative for persons whose condition does not improve with bisphosphonates. The World Health Organization (WHO) 8 has quantified this as forces equivalent to a fall from a standing height or less. You are also at an increased risk of falling and fracturing because of blood sugar levels, declining vision, associated peripheral neuropathy and nerve damage. Moderate risk - QRISK2 of 10-20% Purpose: To estimate a patient's 10-year risk for osteoporotic fracture based on the FRAX WHO fracture risk assessment tool of Kanis et al. Diabetes medicines also increase fracture risk. Copyright 2023 American Academy of Family Physicians. Do you regularly have >2 alcoholic drinks a day? Enter yes if the patient is currently exposed to oral glucocorticoids or has been exposed to oral glucocorticoids for more than 3 months at a dose of prednisolone of 5mg daily or more (or equivalent doses of other glucocorticoids) (see also notes on risk factors). Correlations were calculated between the various methods (Table). The FRAX tool helps toidentify people who may be atrisk of developing osteoporosis. The test usually takes less than 15 minutes. They are not currently taking osteoporosis medication. Do not use dual energy x-ray absorptiometry (DEXA) to screen for osteoporosis in women younger than 65 years or in men younger than 70 years with no risk factors. The lower your T-score, the lower your bone density. The International Osteoporosis Foundation supports the maintenance and development of FRAX. 1.How do you rate your confidence that you could get and keep an erection? The American Bone Health Fracture Risk Calculator (ABH FRC) Version 3.0, published 03/04/2021, estimates 10-year fracture risk for postmenopausal women and men age 45 and older who are not receiving treatment for osteoporosis. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Age (between 40 and 90 years) or Date of Birth, Centre for Metabolic Bone Diseases, University of Sheffield, UK. Did you recently attend an American Bone Health event? GENDER female AGE A balanced diet consisting of vitamin D, calcium, protein, vegetables, and fruits is recommended; mononutrient dietary supplementation is unlikely to be helpful.24 Table 5 shows a comparison of nonpharmacologic therapies.1725, Table 6 summarizes pharmacologic treatments for osteoporosis, including bisphosphonates, raloxifene (Evista), teriparatide (Forteo), and denosumab (Prolia).16,2629, Mild upper gastrointestinal events, esophageal ulcerations, perforations, bleeding events, muscular and joint pains, Contraindications: abnormalities of the esophagus; inability to stand or sit upright for at least 30 minutes; hypersensitivity to any product component; increased risk of aspiration or dysphagia, 70 mg plus 2,800 IU or 5,600 IU per week, oral, 35 mg per week (day 1) plus 1,250 mg calcium per day (days 2 to 7 each week), oral, Contraindications: hypocalcemia creatinine clearance < 35 mL per minute per 1.73 m2 (0.58 mL per second per m2) and acute renal impairment; hypersensitivity to zoledronic acid or any components of this product, Pulmonary embolism, thromboembolic events, Contraindications: venous thromboembolism; pregnancy, women who may become pregnant, and breastfeeding mothers, 20 mcg per day for up to 2 years, subcutaneous, Arthralgia, pain, nausea, transient orthostatic hypotension, hypercalcemia, hyperuricemia, Contraindications: hypersensitivity to teriparatide or to any of its components; reactions have included angioedema and anaphylaxis. Our website services, content, and products are for informational purposes only. Enter "No" if you have other kinds of arthritis, such as osteoarthritis. Secondary osteoporosis No Yes 11. ", Postgraduate Medicine: Primary care use of FRAX: absolute fracture risk assessment in postmenopausal women and older men., University of Sheffield: Calculation Tool, Welcome to FRAX.. Results: According to the FRAX algorithm (without BMD), 61.6% of our cohort require treatment. Without treatment, osteoporosis can cause dangerous bone breaks and shorten life span. The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. This is primarily a screening tool and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture [1] and to target anti-osteoporosis treatments [2] . Search dates: April and July 2014, and May 2015. For the FRAX calculator, answer "yes" if you generally drink more than 2 drinks/day. The filter allows the FRAX score into the DXA report only when the patient does not meet the first two of the NOF treatment criteria (prior hip or vertebral fracture or T-score below 2.5) but could possibly meet the third NOF treatment criterion based on FRAX risk calculation: an untreated postmenopausal woman or man age 50 years or older . This enquires for a history of hip fracture in the patient's mother or father. Calculator Frequently Asked Questions (FAQs) page. More than 10 million Americans have osteoporosis, which is defined by the National Osteoporosis Foundation as a chronic, progressive disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.1 Roughly 50% of white women and 20% of white men have a fracture related to osteoporosis in their lifetime; although black men and women are at lower risk of osteoporosis, those with osteoporosis have similar fracture risk.1 Osteoporotic fractures are associated with increased risk of disability, nursing home placement, total health care costs, and mortality (Table 1).13 Osteoporosis risk increases with age, and its impact will increase as the U.S. population ages.3 Table 2 lists risk factors for osteoporosis.2, 10 million Americans 50 years and older have osteoporosis of the hip, 1.5 million Americans have osteoporotic fracture (40% of women and 10% of men will have a fracture of the hip, spine, or wrist), 10% to 20% increased mortality at one year after a fracture, Total costs projected to rise from $18 billion in 2002 to $25 billion by 2025. 10-Year Fracture Risk Calculator The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. A hip or vertebral (clinical or morphometric) fracture, T-score -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes, Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or spine) and a 10-year probability of a hip fracture 3% or a 10-year probability of a major osteoporosis-related fracture 20% based on the US-adapted WHO algorithm, Clinicians judgment and/or patient preferences may indicate treatment for people with 10-year fracture probabilities above or below these levels. For the FRAX score calculator, you'll have to answer several questions about habits such as alcohol intake and other disorders you may have that are linked to osteoporosis, such as type 1. Learn about infusion options for treating osteoporosis and how they compare to other treatment options. One study found that women who take alendronate for five years followed by five years of placebo have no increased incidence of nonvertebral or hip fractures compared with women who take alendronate for 10 years. Cadarette (2004) Osteoporos Int 15(5):361-366 [PubMed] Last medically reviewed on December 8, 2017. If your FRAX score is 3% or more for hip fracture, or 20% or more for other major osteoporosis fractures, you may be at increased risk of fracture. More aggressive treatment usually includes a type of medication called bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva). The FRAX calculator for the United States is unique in that there exist distinct databases for ethnic minorities. The loss of bone mass makes them weaker and more likely to break if you fall or are otherwise injured. The FRAX models were developed from and validated on population-based cohorts from 4 continents; charts are available for many countries.. The probability of fracture computed may therefore be underestimated. The ABH FRC will give results with or without a bone density test score. Have you ever had a bone density test on a table machine? Additional searches included Essential Evidence Plus, the U.S. Preventive Services Task Force, the Institute for Clinical Systems Improvement, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews, and the National Osteoporosis Foundation website. Age must be greater than or equal to 45 years. 1.4 Use either FRAX [ 8] (without a bone mineral density [BMD] value if a dual-energy X-ray absorptiometry [DXA] scan has not previously been undertaken) or QFracture [ 9 . Garvan Institute Assessment Tool Comparing Bone Demineralization and Osteoporosis, What to Know About Osteoporosis and Your Spine, What You Need to Know About Gaucher Disease and Osteoporosis, A Complete Guide to Infusions for Osteoporosis, 4 Types of Exercises and Activities to Avoid When You Have Osteoporosis. Clinicians should consider discontinuing bisphosphonate therapy after five years in women without a personal history of vertebral fractures. FRAX is short for Fracture Risk Assessment Tool. Patient does not provide medical advice, diagnosis or treatment. All information should be verified by a qualified health professional, and all use is subject to Medicalalgorithms.com Terms and Conditions. Osteoporosis is diagnosed radiographically based on bone mineral density (BMD) determinations from dual energy x-ray absorptiometry (DEXA) assessment.4 Although quantitative calcaneal ultrasonography and peripheral DEXA can also predict fracture risk, these modalities do not correlate well enough with central DEXA to be used diagnostically.1,5,6 The World Health Organization (WHO) established commonly accepted definitions of osteoporosis and osteopenia4 (Table 36 ). One drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits (80 proof). 7 mechanical forces that would not ordinarily result in fracture. The FRAX algorithms give the 10-year probability of fracture. However, FRAX was neither developed or endorsed by WHO . Enter your Femoral Neck T-score as a decimal number. Women who smoke go through menopause at a younger age than women who dont smoke. 2.When you had erections with sexual stimulation, how often were your erections hard enough for penetration? Objective. Assessment of absolute fracture risk, using either the Garvan Fracture Risk Calculator or the Fracture Risk Assessment Tool (www.shef.ac.uk/FRAX) may be useful in assessing the need for treatment in individuals who do not clearly fit established criteria. Predicts risk of pathologic fracture in patients with long bone metastasis. Enter No if you have used creams, gels, or inhaled steroids intermittently. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Any clinician can use this calculator [3] to predict the probability . FRAX is a clinical tool for assessing the risk of fractures in people with osteoporosis. Raloxifene. Causes, symptoms, risk factors, and treatment. . Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use. This content is owned by the AAFP. To compare the power of FRAX without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. If you have a spine fracture, you are four times as likely to have another spine fracture. Bone health is primarily determined by dual energy x-ray absorptiometry (DXA) scanning after women have been screened for possible disease. Are you taking a prescription medicine for osteoporosis? Enter "Yes" if you drink 3 or more alcoholic beverages a day. Getting more exercise, including weight-bearing activities, is helpful too. The QFracture and FRAX risk assessment tools predict the absolute risk of hip fracture, and major osteoporotic fractures (spine, wrist, or shoulder) over 10 years. The FRAXalgorithms give the 10-year probability of fracture. Methods: Fracture risk was calculated using the different screening tools (FRAX, OST, ORAI, OSIRIS and SCORE) for each woman. Your doctor will order a bone density test.