FRAX Score (10-Year Fracture Risk)
Estimate 10-year probability of major osteoporotic fracture (hip, spine, forearm, humerus) and hip fracture. Simplified risk-factor-based screening for clinic use.
Major osteoporotic fx (10y)
13.0%
Hip + spine + forearm + humerus
Hip fracture (10y)
4.8%
BMI 23.4
Recommendation
High risk (Indian treatment threshold met). Initiate pharmacologic therapy: oral bisphosphonate (alendronate 70 mg/week, risedronate 35 mg/week) is first-line; zoledronate 5 mg IV/year for non-adherent. Consider denosumab if eGFR <35. Pair with calcium + vitamin D.
Build an osteoporosis prevention pathway
EasyClinic auto-runs FRAX on every postmenopausal patient, schedules DXA when indicated, and tracks bisphosphonate adherence — for orthopaedics, OBGYN and family medicine clinics.
Also Known As
What is FRAX?
The FRAX tool was developed by the WHO Collaborating Centre at Sheffield to estimate a patient's 10-year probability of major osteoporotic fracture and hip fracture using readily available clinical risk factors, with or without femoral neck BMD.
Indian treatment thresholds
- Major osteoporotic fracture ≥ 20% in 10 years → start pharmacologic therapy
- Hip fracture ≥ 3% in 10 years → start pharmacologic therapy
- T-score ≤ -2.5 at any site → osteoporosis, treat regardless of FRAX
- T-score -1.0 to -2.5 with high FRAX → treat (osteopenia + high risk)
First-line therapy in India
- Alendronate 70 mg PO weekly (Aldron, Restofos) — ~₹100-150/month
- Risedronate 35 mg PO weekly (Actonel, Risofos) — ~₹200-300/month
- Zoledronate 5 mg IV once a year (Zoldria, Osteofos) — ~₹4,000-6,000/dose, best for non-adherent or GI intolerant
- Denosumab 60 mg SC every 6 months (Prolia) — premium option (~₹15,000/dose), preferred if eGFR < 35
- Always pair with: Calcium 1000-1200 mg/day, Vitamin D₃ 800-1000 IU/day
Frequently Asked Questions
▸Should I screen all postmenopausal women?
Per ISBMR/IOF: screen all women ≥ 65y, and women 50-64y with risk factors (prior fragility fx, parental hip fx, smoker, low BMI, steroids, RA, alcohol).
▸When should I order DXA?
When FRAX is in intermediate range (10-19% major, 1-3% hip), or in all patients ≥ 65y who have not had DXA in the last 2 years.
▸Is FRAX validated in Indian patients?
India does not have a country-specific FRAX cohort — most clinicians use the FRAX India model (recently added) or the South Asian / UK model with caution. ISBMR endorses simplified risk assessment plus DXA where available.
▸How long should bisphosphonate therapy continue?
Typically 5 years for oral alendronate/risedronate, 3 years for IV zoledronate, then drug holiday with re-assessment. High-risk patients may continue up to 10 years.
▸What if my patient has GERD or oesophageal stricture?
Avoid oral bisphosphonates. Use IV zoledronate or subcutaneous denosumab instead.
References
- Kanis JA et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:385-97
- ISCD-IOF FRAX Position Development Conference 2019
- Indian Society for Bone and Mineral Research (ISBMR) Position Statement on Osteoporosis 2018
- Cardiological Society of India (CSI) — Osteoporosis Treatment Guidelines
Screen every menopausal patient automatically
EasyClinic flags FRAX-eligible patients at every visit, integrates DXA reports, and sets bisphosphonate reminders — early prevention without manual tracking.
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