The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide information on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distinguished from diagnosis to take account of the independent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip fracture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The independent contribution of these risk factors can be integrated by the calculation of fracture probability with or without the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold.

This paper reviews briefly the development and clinical use of FRAX in the development of assessment guidelines for osteoporosis.Fractures are the clinical consequence of osteoporosis and are a major cause of morbidity and mortality worldwide. Several treatments are available that have been shown to decrease the risk of fracture, but problems arise in identifying individuals at high fracture risk so that treatments can be effectively targeted. Case finding can be enhanced by the consideration of clinical risk factors that provide information on fracture risk over and above that provided by bone mineral density measurements. The FRAX tool integrates information on fracture risk from clinical risk factors with or without the use of BMD and can be used to improve the targeting of individuals at high fracture risk.

Guidance for glucocorticoid-induced osteoporosis is updated in the light of new treatments and methods of assessment. National guidelines derived from this resource need to be tailored within the national healthcare framework of each country.

The study provides a method of developing management algorithms for osteoporosis from the estimation of fracture probabilities, rather than those based on BMD alone or BMD with single or multiple CRFs.