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Discover the advantages of FRAXplus®

FRAXplus® allows you to modify a probability result derived from conventional FRAX estimates of probabilities of hip fracture and major osteoporotic fracture with knowledge of:

  • Recency of osteoporotic fracture
  • Higher than average exposure to oral glucocorticoids
  • Information on trabecular bone score (TBS)
  • Number of falls in the previous year
  • Duration of Type 2 diabetes mellitus
  • Concurrent information on lumbar spine BMD
  • Hip axis length (HAL)

Caveat : There is no evidence base available to inform on the accuracy of multiple adjustments. Pragmatically, any adjustment should be made for the most dominant factor, i.e., that which is likely to have the greatest clinical relevance for the estimated probability.

For guidance on choosing a single risk adjustment in an individual with multiple potential adjustments, please click here.

The risk of a recurrent fragility fracture is particularly high immediately following the fracture. FRAXplus® provides adjustments to FRAX-based fracture probabilities accounting for the site of a recent fracture [Kanis 2020].

Reference: Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu M, Vandenput L, McCloskey E (2020) Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures. Osteoporosis International 31: 1817-1828.

Moderate doses of glucocorticoids (2.5–7.5 mg prednisolone daily or equivalent) are the assumed exposure in the FRAX calculation. For high doses (>7.5 mg daily), MOF probabilities are upward revised by about 15% and hip fracture probabilities by 20%. Simple adjustments can be made by hand and are available [Kanis et al 2011]. FRAXplus® gives a more accurate adjustment based on empirical data.

Reference: Kanis JA, Johansson H, Oden A, McCloskey EV (2011)Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22(3): 809-16.

FRAX underestimates fracture risk in patients with type 2 diabetes. Several methods for adjusting fracture probabilities have been proposed [Leslie 2018]. The most simple is to enter ‘yes’ in the rheumatoid arthritis input to FRAX.
FRAXplus® incorporates a further adjustment for the duration of Type 2 diabetes mellitus which also influences fracture risk.

Reference: Leslie WD, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D (2018) Comparison of methods for improving fracture risk assessment in diabetes: The Manitoba BMD Registry. J Bone Mineral Res 33: 1923-30.

Major discordances between lumbar spine (LS) and femoral neck (FN) BMD T-scores are relatively uncommon but may enhance the assessment of major osteoporotic fracture (MOF) risk where they exist. Generally, a much higher LS T-score than FN T-score will lower MOF, and vice versa. FRAXplus® allows easy incorporation of this discordance where required.

Reference: Johansson H, Kanis JA, Oden A, Leslie WD et al. (2014). Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: a meta-analysis of international cohorts. Calcif Tissue Int, 95(5), 428-435.

The Trabecular Bone Score (TBS) is derived from the texture of the DXA image at the lumbar spine and provides an index of bone microarchitecture. A low TBS is associated with an increased risk of fracture independent of FRAX and femoral neck BMD. FRAXplus® provides access to a validated adjustment [McCloskey 2015, 2016]. TBS values calculated with TBS iNsight version 2.1 and above can be used to compute FRAX adjusted for TBS. (only available when BMD obtained from GE-Lunar or Hologic devices).

Reference McCloskey EV, Odén A, Harvey NC, et al (2016) A meta-analysis of Trabecular Bone Score in fracture risk prediction and its relationship to FRAX. J Bone Mineral Res 31: 940-8.

A history of falls is associated with increased hip and MOF fracture risk. FRAX currently assumes an average exposure to falls in the last year. Adjustments for a history of 0, 1, 2 and 3 or more falls in the previous year have been derived from an analysis within the Manitoba cohort and implemented within FRAXplus®.

Reference: Kanis JA, Johansson H, Harvey NC, Lorentzon M, Liu E, Vandenput L, Morin S, Leslie WD, McCloskey EV (2023). Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year. Osteoporos Int, 34(3), 479-487.

Longer than average hip axis length (HAL) is associated with an increase in hip fracture risk. Conversely, shorter than average length is associated with a lower risk. FRAXplus® enables an adjustment of FRAX hip fracture probability for the measured HAL.

In addition to FRAX score adjustments, FRAXplus® offers many helpful features accessible via 'My FRAX':

  • User icon

    1 / User Account

    Enter and manage your personal data in order to save time when connecting in the future.

  • Saved icon

    2 / Results are saved

    Your results, scores and risk variables will be saved in your personal user account for future reference and use.

  • History icon

    3 / History / Log

    Keep track of your past tests to easily access a history of your activities and results.

  • PDF icon

    4 / PDF export

    Easily export your results in a pdf file to avoid transcription errors and any loss of data.

  • Email icon

    5 / Send by email feature

    An intuitive way to share your results by email.

  • Synchronisation icon

    6 / Synchronisation between devices

    Benefit from an automatic synchronisation of your results between several devices (phone, tablet, computer, etc.)