If you’ve had a DEXA scan, you may have noticed a statement on the report that reads something like this: “This test suggests that you have a __% risk of fracturing a hip within the next 10 years.” Depending on what that magic number is, you may be very concerned about your potential fracture risk, or you may be thinking, “Great! Nothing to worry about there!” Either way, you may want to take the number with a grain of salt. Here’s why:
Concerns about the FRAX and calculations
- There are some pretty serious concerns about how the FRAX makes its calculation — serious enough that the World Health Organization (WHO) has disavowed the tool and its recommendations (Ford et al., 2016).
- No one, apart from the people who developed it, knows how the FRAX calculation works (not even WHO).
- Even though nutritional deficits like vitamin D deficiency are known to play a major role in bone health and fracture risk, the tool doesn’t include them anywhere — a really key omission. Instead, they use a list of 10 rather general risk factors that barely scratch the surface.
- If your 10-year risk of hip fracture is ≥3% or of any other major osteoporotic fractures is ≥20%, you will be recommended bone drugs. Ditto if you have bone density T score of –2.5 or more. Yet according to these standards, most women would be told to take bone drugs as they age (Donaldson et al., 2009) — and many experts agree that medicating the majority of women isn’t needed or beneficial.
FRAX calculation tool for Caucasian women in U.S.
So what does my result mean?
Here’s where the grain of salt comes in. On the one hand, you shouldn’t be alarmed by a prediction that shows you to be at relatively greater risk of fracture — and I say this in full understanding that one-third of all women in the U.S. likely will experience a meaningful osteoporotic fracture in their lifetime. The older we get and the more health problems we have, the greater the risk of fracture, but an individual’s risk for such fractures can be greatly reduced with appropriate nutrition and lifestyle modifications.
On the other hand, you should consider it a wake-up call encouraging you make an assessment — a comprehensive one! — of what factors you have that you might address to reduce your risk of fracture. I have dedicated my life’s work to helping people make such assessments, and this website offers plenty of information for strengthening bone at any stage of your life.
Take heart and take action. Consider making it an adventure to reduce your fracture risk factors and rebuild skeletal and overall health. For a more comprehensive fracture risk assessment take my Bone Health Profile.
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
Donaldson M.G. et al. Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res. 2009 Apr; 24(4): 675–680. Published online 2008 Dec 1. doi: 10.1359/JBMR.081203
I’m Dr. Susan Brown. I am a nutritionist, medical anthropologist, writer, and speaker. Get my free weekly newsletter here.