Estimate 10-year fracture risk using clinical risk factors. Includes FRAX-style assessment with major osteoporotic and hip fracture risk calculation.
This osteoporosis risk calculator estimates 10-year probabilities of major osteoporotic fracture and hip fracture based on clinical risk factors. The assessment incorporates key FRAX (Fracture Risk Assessment Tool) risk factors: age, sex, BMI, prior fracture, parental hip fracture, glucocorticoid use, smoking, alcohol use, and rheumatoid arthritis.
Osteoporosis affects over 200 million people worldwide and is responsible for approximately 8.9 million fractures annually. Hip fractures carry 20-30% one-year mortality in elderly patients and are a leading cause of disability and loss of independence. Early identification of high-risk individuals enables preventive intervention before fractures occur.
The WHO FRAX tool (available at sheffield.ac.uk/FRAX) is the gold standard for clinical fracture risk assessment and can incorporate DXA-measured bone mineral density. This calculator provides a simplified clinical risk factor assessment suitable for initial screening and patient education. Check the example with realistic values before reporting. Use the steps shown to verify rounding and units. Cross-check this output using a known reference case.
Fracture risk assessment guides three critical clinical decisions: (1) Who should receive DEXA bone density testing, (2) Who should receive pharmacologic treatment for osteoporosis, and (3) How aggressively to pursue fall prevention and lifestyle modification.
The NOF/AACE treatment threshold (10-year major fracture risk ≥20% or hip fracture risk ≥3%) means that identifying patients above these thresholds can prevent fractures through timely pharmacotherapy.
Simplified Risk Estimation (based on FRAX risk factors): Base risk + age contribution + sex adjustment + risk factor contributions Risk factors scored: - Prior fragility fracture (+8%) - Glucocorticoid use (+5%) - Parental hip fracture (+4%) - Female sex (+3%), Post-menopause (+3%) - Rheumatoid arthritis (+3%), Low BMI (+3%) - Smoking (+2%), Alcohol ≥3 units/day (+2%) OSTA = 0.2 × (weight in kg − age in years) <−1: High risk | −1 to 3: Moderate | >3: Low
Result: 10-year major fracture risk 11% — Moderate Risk
A 65-year-old post-menopausal woman with no prior fractures has a moderate risk. A DEXA scan is recommended to measure bone mineral density. If T-score is ≤−2.5, pharmacologic treatment is indicated. Calcium (1200mg/day), vitamin D (1000-2000 IU/day), and weight-bearing exercise should be initiated.
Bone mineral density (T-score) is only one component of fracture risk. Two patients with the same T-score can have very different fracture odds if one has prior fractures, glucocorticoid use, and a family history while the other has none of these factors. FRAX integrates clinical risk factors with BMD to generate a more accurate fracture probability.
The NOF recommends pharmacotherapy when: (1) T-score ≤−2.5 at hip or spine, (2) hip fracture, (3) vertebral fracture, OR (4) FRAX 10-year major fracture risk ≥20% or hip fracture risk ≥3%. The NOGG (UK) uses a graphical age-dependent threshold. The American College of Rheumatology has separate, more aggressive guidelines for glucocorticoid-induced osteoporosis.
Romosozumab (anti-sclerostin antibody) is a dual-action agent that both builds bone and reduces resorption. It is the most potent treatment available, producing ~15% BMD gain at the spine in 12 months. Abaloparatide (PTHrP analog) is another anabolic option. Sequential therapy (anabolic first, then anti-resorptive) is increasingly recommended for high-risk patients.
A fragility fracture occurs from a fall from standing height or less — a force that would not normally break healthy bone. Common sites: vertebral compression fractures, distal radius (wrist), proximal femur (hip), and proximal humerus. A fragility fracture is itself diagnostic of osteoporosis regardless of bone density.
DEXA is recommended for: all women ≥65 and men ≥70 (universal screening), post-menopausal women <65 and men 50-69 with risk factors, anyone with a fragility fracture, and anyone on long-term glucocorticoids. DEXA should also be considered when fracture risk assessment falls in the moderate range and bone density would change management.
The WHO defines: Normal: T-score ≥ −1.0, Osteopenia: T-score −1.0 to −2.5, Osteoporosis: T-score ≤ −2.5, Severe osteoporosis: T-score ≤ −2.5 with a fragility fracture. T-scores compare bone density to a young adult reference population.
Glucocorticoids (prednisone ≥5mg/day for ≥3 months) are the most common cause of secondary osteoporosis. They decrease bone formation, increase bone resorption, reduce calcium absorption, and cause myopathy (increasing fall risk). The ACR recommends fracture risk assessment and preventive therapy for all patients on chronic glucocorticoids.
Key interventions: calcium 1000-1200mg/day (diet + supplement), vitamin D 1000-2000 IU/day, weight-bearing and resistance exercise (30+ min most days), fall prevention (home safety, vision correction, medication review), smoking cessation, limiting alcohol to <3 units/day, and maintaining adequate protein intake. Use this as a practical reminder before finalizing the result.
Bisphosphonates: after 3-5 years, consider a "drug holiday" for moderate-risk patients (residual benefits persist for 1-2 years). High-risk patients should continue. Denosumab: discontinuation causes rapid bone loss and rebound fractures — must be followed by a bisphosphonate. Anabolic agents (teriparatide, romosozumab): limited to 1-2 years, then transition to anti-resorptive therapy.