The fracture risk tool known as FRAX has come under fire from the World Health Organization (WHO) recently for several reasons. One key reason is that, although it’s often referred to as the “WHO FRAX tool” and was developed at a WHO “collaborating center” at Sheffield University, the FRAX fracture risk tool was not developed, evaluated, endorsed, or validated by WHO itself (Ford et al., 2016).
In fact, WHO’s health policy organization has no access to the algorithms, coefficients, or underlying data on which the FRAX tool was developed (nor does anyone else, for that matter!).
FRAX uses these risk factors
The only thing we know about how FRAX works are the risk factors they use in making the prediction:
- Personal history of fracture
- Family history of hip fracture
- Corticosteroid use
- Rheumatoid arthritis
- Secondary causes of osteoporosis
- Heavy alcohol use
What FRAX doesn’t do
All of these are factors that affect osteoporosis risk, but they’re far from a complete picture. Among the more glaring omissions: FRAX gathers no data on intake of bone-building nutrients like calcium, vitamin D, vitamin K, and magnesium — all widely known to be vital to bone health — and it does not ask women about their menopause status. Given the fact that menopause looms large in determining a woman’s bone density (which is part of the data they ask for), that’s a pretty serious oversight!
Even more telling is the fact that the FRAX risk assessments are used as a basis of a recommendation for bone drugs. Keeping in mind that the tool has not been evaluated or endorsed by the WHO, the world’s premier health policy-making body, you have to wonder what the basis of a recommendation might be that omits so many key risk factors.
It may become clearer once you know that the FRAX was developed by researchers with vested interests in drug therapies for osteoporosis — a bias that encourages overtreatment of women concerned about their bone health. In fact, well respected osteoporosis researchers determined that if the FRAX criteria, which are endorsed by the U.S. National Osteoporosis Foundation, were applied universally, almost 75% of U.S. Caucasian women 65 or over and a staggering 93% of those 75 or older would be candidates for osteoporosis drug treatment.
For these reasons, I tell my clients and readers, “consider the source” of the information coming from this tool. You may want to try my simple but reliable Bone Health Profile to assess the health of your bones and your potential risk of fracture.
Ford N., Norris S.L., Hill S.R. Clarifying WHO’s position on the FRAX® tool for fracture prediction. Bull World Health Organ 2016;94:862 | doi: http://dx.doi.org/10.2471/BLT.16.188532