Bone health FRAX overview

Overview

FRAX is a tool your doctor may use to estimate your chance of breaking a bone (fracture) in the next 10 years. It stands for Fracture Risk Assessment Tool. It helps decide whether you need extra steps to protect your bones.

Yes, doctors around the world regularly use FRAX to check bone health, especially for people who have gone through menopause or have other risk factors.

FRAX is used for anyone who may be at higher risk of osteoporosis or fractures. This includes older adults, people with a family history of hip fractures, those who have taken steroid medicines for a long time, and women after menopause.

Symptoms

Common symptoms

• FRAX itself does not cause symptoms — it is a calculation.
• Conditions that lead to a high FRAX score, such as osteoporosis, often have no symptoms until a bone breaks.

Symptoms in children

• FRAX is not used for children. If a child has broken a bone easily, a doctor will look for other causes.

Symptoms in older adults

• A fracture that happens from a minor fall (like tripping on a rug) can be a sign of weak bones.
• Loss of height over time or a curved upper back (sometimes called a dowager’s hump) may indicate spine fractures.

Causes

Main causes

• Bones naturally become thinner and weaker with age.
• A drop in estrogen after menopause speeds up bone loss in women.
• Low bone density (osteoporosis) makes fractures more likely.

Risk factors

• Being over 50 years old.
• Having a parent who broke a hip.
• Smoking cigarettes or drinking more than a moderate amount of alcohol.
• Taking oral steroids (like prednisone) for 3 months or more.
• Having rheumatoid arthritis or other inflammatory conditions.
• Being underweight (BMI below 19).
• Not getting enough calcium or vitamin D.

When to see a doctor

See a doctor urgently if:

• If you have broken a bone from a very minor fall or no fall at all.
• If you have sudden, severe back pain that may be a spine fracture.

Book a routine appointment if:

• Women aged 65 and older, and men aged 70 and older, should talk to their doctor about bone health screening.
• Younger adults with risk factors (like long-term steroid use, early menopause, or a previous fracture) can ask for a FRAX assessment.

Diagnosis

FRAX is not a test you take yourself. Your doctor or nurse will ask you questions about your health and sometimes use a bone density scan (DXA) to get your FRAX score.

Tests that may be done

• FRAX questionnaire (your answers to risk factor questions).
• Bone mineral density test (DXA) – a quick, painless X-ray of your hip and spine.
• Blood tests may be done to check for other conditions that affect bones.

What to expect at your appointment

During a bone health check, your doctor will ask about your age, weight, height, lifestyle, medical history, and any family history of fractures. If a DXA scan is done, you lie on a padded table while a scanner passes over you. It takes about 10–15 minutes. Your results are given as a percentage — your 10‑year chance of a fracture.

Treatment

If your FRAX score shows you are at high risk, your doctor will suggest ways to strengthen your bones and lower your chance of breaking one. Treatment focuses on lifestyle changes and, if needed, medicines that help keep bone strong.

Self-care at home

• Get enough calcium from foods like milk, yogurt, cheese, leafy greens, and fortified cereals.
• Make sure you get enough vitamin D – from sunlight (short periods), or from foods like oily fish and eggs.
• Do weight-bearing exercises like walking, dancing, or climbing stairs, and resistance exercises like lifting light weights.

Medical treatments

If lifestyle changes are not enough, doctors may prescribe medicines that help slow bone loss or build new bone. These are taken as tablets, injections, or infusions. The choice depends on your age, your FRAX score, and your overall health. Always follow your doctor’s advice and never start or stop any bone medicine without talking to them.

When is surgery considered?

Surgery is not used to treat a high FRAX score. But if a fracture does happen, surgery may be needed to fix broken bones, for example, a hip replacement or pins to hold a wrist fracture together.

Living with this condition

If you have a high fracture risk, you can still live fully. Simple changes around the home — like removing loose rugs, putting grab bars in the shower, and using good lighting — help prevent falls.

Lifestyle tips

• Avoid smoking and limit alcohol to no more than 1–2 drinks per day.
• Stay active with exercises that improve balance, like tai chi or yoga.
• Wear sturdy, non‑slip shoes.

Diet and exercise

A bone‑healthy diet includes plenty of calcium and vitamin D. Aim for three servings of dairy or fortified alternatives each day. For vitamin D, a daily supplement of 10 micrograms (400 IU) is often recommended for everyone in the UK during autumn and winter. Exercise should include at least 30 minutes of weight‑bearing activity on most days.

Mental health and emotional wellbeing

Worrying about fractures can be stressful. If you feel anxious or depressed about your bone health, talk to your doctor or a counsellor. Staying connected with friends and family can also help you feel supported.

Prevention

You cannot stop bones from thinning with age, but you can slow the process. Eating well, staying active, not smoking, and managing risk factors like steroid use all help.

Screening programmes

Screening for osteoporosis is not routine for everyone. In the UK, the NHS offers a fracture risk assessment (using FRAX or a similar tool) to women aged 65 and older, and to younger people with risk factors. If you are concerned, ask your doctor for a bone health check.

Complications

If left untreated

• Broken hip — can cause long‑term mobility problems.
• Spine fractures — can lead to chronic back pain and loss of height.
• Wrist and arm fractures — can make daily tasks difficult.

Long-term outlook

With the right steps — good nutrition, exercise, and sometimes medication — most people can keep their bones healthy and avoid fractures. Even if you have a high FRAX score, the outlook is hopeful. Treatment can reduce your fracture risk by 30–50%.

Find support

International organisations

• International Osteoporosis Foundation

Local organisations

• NHS (UK) – Bone health · United Kingdom

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