Work out if you’re at risk of developing osteoporosis and breaking a bone in the next 10 years.
The online Fracture Risk Assessment Tool (FRAX) uses a range of risk factors to predict a person’s risk of fracture because of weak bones.
The self-assessment tool gives a 10-year probability of a fracture in the spine, hip, shoulder or wrist for people aged between 40 and 90.
Estimating your fracture risk could be the first step to getting early treatment to strengthen your bones and reduce your fracture risk.
“Osteoporosis treatment has shown to reduce the risk of fracture by 30 to 50%,” says Professor Anthony Woolf, a rheumatologist at the Royal Cornwall Hospitals NHS Trust. “It’s never too late for someone to start treatment.”
Osteoporosis is usually diagnosed with a bone density scan (called a DEXA or DXA scan). However, low bone density is not a perfect measure of fracture risk and needs to be considered alongside other risks, such as age, gender, general health and genes.
The FRAX tool, which can be done without a DEXA score, can be a prompt for further discussion about your bone health with your GP to see if a DXA scan is necessary to estimate your risk of future fracture.
“There is more to fracture risk than just bone density,” says Sarah Leyland of the National Osteoporosis Society.
“There are people who have low bone density who never break a bone and there are people who break a bone with minimal force and yet their bone density isn’t in the osteoporosis range,” says Leyland. “Tools like FRAX take into consideration a range of proven risk factors for breaking bones, meaning a DEXA isn’t always necessary.”
Osteoporosis risk factors
The main risk factors for developing osteoporosis and fractures, some of which are used by the FRAX tool, are:
Age: as we get older, bones become more fragile and more likely to break generally, whatever your bone density.
Genes: a family history of osteoporosis increases your risk. In families with smaller bones, fractures, especially of the hip, are more common.
Race: black people are at a lower risk than white or Asian people because their bones tend to be bigger and stronger.
Gender: women have smaller bones than men and lose bone naturally due to the menopause.
Low body weight: a BMI below 19 is often associated with smaller and finer bones and less body fat, which can be protective in a fall.
Diet: a diet lacking in sufficient levels of calcium and vitamin D is associated with weaker bones.
Exercise: regular physical activity has been shown to build strong bones during youth and reduce the rate of bone loss as we get older.
Smoking: research shows regular smokers have weaker bones, although the exact role tobacco plays in osteoporosis isn't clearly understood.
Alcohol: excessive alcohol consumption is thought to affect your ability to absorb calcium, which can result in weaker bones.
Previous fractures: if you’ve already broken bones easily, you are much more likely to have fractures in the future.
Anorexia: a low food intake can cause calcium deficiency, causing weak bones. In women, anorexia can stop menstruation, which also weakens bones.
Steroids: taking prednisolone (a type of steroid) for more than three months can cause weaker bones.
Diabetes: people with type 1 diabetes require medication because they can’t produce insulin, a hormone thought to promote bone strength.
Thyroid problems: too much thyroid hormone, because of an overactive thyroid or hormone treatment for an underactive thyroid, can cause bone loss.
Lack of testosterone: a reduction of the sex hormone testosterone as a result of ageing or illness, such as cancer, is associated with weaker bones.
Premature menopause: women who have menopause before the age of 45 have lower oestrogen levels, which can cause lower bone density.
You cannot see or feel your bones getting thinner and many people are unaware of any problems until they break a bone.
If you think you have risk factors for osteoporosis and fractures then you should discuss this with your GP.