For the clinical risk factors a yes or no response is asked for. If the field is left blank, then a "no" response is assumed. See also

The risk factors used are the following:

Age

The model accepts ages between 40 and 90 years. If ages below or above are entered, the program will compute probabilities at 40 and 90 years, respectively.

Sex

Male or female. Enter as appropriate.

Weight

This should be entered in kg or pounds (please select units)

Height

This should be entered in cm or inches (please select units)

Previous fracture

A previous fracture denotes more accurately a previous fracture in adult life occurring spontaneously, or a fracture arising from trauma which, in a healthy individual, would not have resulted in a fracture. Enter yes or no (see also notes on risk factors).

Parent fractured hip

This enquires for a history of hip fracture in the patient's mother or father. Enter yes or no.

Current smoking

Enter yes or no depending on whether the patient currently smokes tobacco (see also notes on risk factors).

Glucocorticoids

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).

Rheumatoid arthritis

Enter yes where the patient has a confirmed diagnosis of rheumatoid arthritis. Otherwise enter no (see also notes on risk factors).

Secondary osteoporosis

Enter yes if the patient has a disorder strongly associated with osteoporosis. These include type I (insulin-dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition or malabsorption, chronic renal failure (dialysis independent) and chronic liver disease.

Alcohol 3 or more units/day

Enter yes if the patient takes 3 or more units of alcohol daily. A unit of alcohol varies slightly in different countries from 8-10g of alcohol. This is equivalent to a standard glass of beer (285ml), a single measure of spirits (30ml), a medium-sized glass of wine (120ml), or 1 measure of an aperitif (60ml) (see also notes on risk factors).

Bone mineral density (BMD)

In patients without a BMD test, the field should be left blank. If entering absolute BMD - Please select make of scanning equipment used and enter actual femoral neck BMD (in g/cm2). If entering T-score - Please select the T-score option and enter the T-score based on the NHANES III female reference data. See also notes on risk factors.

Notes on risk factors Previous fracture

A special situation pertains to a prior history of vertebral fracture. A fracture detected as a radiographic observation alone (a morphometric vertebral fracture) counts as a previous fracture. A prior clinical vertebral fracture or a hip fracture is an especially strong risk factor, and the probability of fracture may therefore be underestimated. A fracture within the past 2 years is a particularly strong risk factor for subsequent fracture, and fracture probability is also likely to be underestimated with multiple prior fractures. Adjustments of FRAX probabilities for recency or number of prior fractures are available using FRAXplus®.

These risk factors appear to have a dose-dependent effect, i.e. the higher the exposure, the greater the risk. Current FRAX computations assume average exposure and clinical judgment should be used for low or high exposures. FRAX probabilities can be adjusted using FRAXplus® for exposure to higher-than-average doses of glucocorticoids.

RA is a risk factor for fracture. However, osteoarthritis is, if anything, protective. For this reason, reliance should not be placed on a patient's report of 'arthritis' unless there is clinical or laboratory evidence to support the diagnosis.

The site and reference technology is DXA at the femoral neck. T-scores are based on the NHANES reference values for women age 20-29 years. The same absolute values are used in men.