{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:51:29Z","timestamp":1787021489915,"version":"build-2736575974"},"reference-count":67,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"10","license":[{"start":{"date-parts":[[2012,10,1]],"date-time":"2012-10-01T00:00:00Z","timestamp":1349049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:p>Osteoporosis is common and the health and financial cost of fragility fractures is considerable. The burden of cardiovascular disease has been reduced dramatically by identifying and targeting those most at risk. A similar approach is potentially possible in the context of fragility fractures. The World Health Organization created and endorsed the use of FRAX, a fracture risk assessment tool, which uses selected risk factors to calculate a quantitative, patient-specific, ten-year risk of sustaining a fragility fracture. Treatment can thus be based on this as well as on measured bone mineral density. It may also be used to determine at-risk individuals, who should undergo bone densitometry. FRAX has been incorporated into the national osteoporosis guidelines of countries in the Americas, Europe, the Far East and Australasia. The United Kingdom National Institute for Health and Clinical Excellence also advocates its use in their guidance on the assessment of the risk of fragility fracture, and it may become an important tool to combat the health challenges posed by fragility fractures.<\/jats:p>","DOI":"10.1302\/0301-620x.94b10.28889","type":"journal-article","created":{"date-parts":[[2012,9,26]],"date-time":"2012-09-26T21:57:24Z","timestamp":1348696644000},"page":"1313-1320","source":"Crossref","is-referenced-by-count":23,"title":["FRAX and the assessment of the risk of developing a fragility fracture"],"prefix":"10.1302","volume":"94-B","author":[{"given":"R. G.","family":"Middleton","sequence":"first","affiliation":[{"name":"Cheltenham General Hospital, Sandford\rRoad, Cheltenham, Gloucestershire\rGL53 7AN, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Shabani","sequence":"additional","affiliation":[{"name":"Royal National Orthopaedic Hospital, 45\rBolsover Street, London W1W 5AQ, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. E.","family":"Uzoigwe","sequence":"additional","affiliation":[{"name":"Leicester General Hospital, Gwendolen\rRoad, Leicester LE5 4PW, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Moqsith","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary, Infirmary\rSquare, Leicester LE1 5WW, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Venkatesan","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary, Infirmary\rSquare, Leicester LE1 5WW, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","unstructured":"Kanis JA.\n                      World Health Organization Collaborating Centre for Metabolic Bone Diseases. Assessment of osteoporosis at the primary health-care level. http:\/\/www.shef.ac.uk\/FRAX\/pdfs\/WHO_Technical_Report.pdf (date last accessed 8 June 2012."},{"key":"r2","unstructured":"Goklany IM.\n                      The improving state of the world: why we're living longer, healthier, more comfortable lives on a cleaner planet\n                      . Washington: Cato Institute, 2007."},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdq074"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1462"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.50"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.061113"},{"key":"r7","unstructured":"No authors listed.\n                      Bone health and osteoporosis: a report of the Surgeon General\n                      . Rockville: US Department of Health and Human Services, Office of the Surgeon General, 2004."},{"key":"r8","doi-asserted-by":"crossref","first-page":"9080","DOI":"10.1007\/s11657-011-0060-1","volume":"6","author":"Str\u00f6m O","year":"2011","journal-title":"Arch Osteoporos"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-009-0925-y"},{"key":"r10","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.5694\/j.1326-5377.2004.tb05908.x","volume":"180","author":"Nguyen TV","year":"2004","journal-title":"Med J Aust"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-004-1680-8"},{"key":"r12","unstructured":"No authors listed.\n                      World Health Organization. The world health report 1997: conquering suffering, enriching humanity. http:\/\/www.who.int\/whr\/1997\/en\/index.html (date last accessed 8 June 2012)."},{"key":"r13","unstructured":"No authors listed.\n                      World Health Organization Geneva. Guidelines for preclinical evaluation and clinical trials in osteoporosis, 1998:59. http:\/\/whqlibdoc.who.int\/publications\/1998\/9241545224_eng.pdf (date last accessed 8 June 2012)."},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1007\/s001980050281"},{"key":"r15","unstructured":"No authors listed.\n                      British Geriatrics Society. The care of patients with fragility fracture (\u201cblue book\u201d), 2007. http:\/\/www.bgs.org.uk\/index.php?option=com_content&\nview=article&\nid=338:bluebookfragilityfracture&\ncatid=47:fallsandbones&\nItemid=147 (date last accessed 8 June 2012)."},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1007\/s001980050280"},{"key":"r17","unstructured":"No authors listed.\n                      National Institute for Health and Clinical Excellence. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended), 2011 (TA160). http:\/\/www.nice.org.uk\/guidance\/TA160\/Guidance\/pdf (date last accessed 8 June 2012)."},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2005.06.004"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.10.1108"},{"key":"r20","unstructured":"No authors listed.\n                      World Health Organization Geneva. Prevention and management of osteoporosis, 2003. http:\/\/whqlibdoc.who.int\/trs\/WHO_TRS_921.pdf (date last accessed 8 June 2012)."},{"key":"r21","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.00919"},{"key":"r22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199006073222304"},{"key":"r23","unstructured":"No authors listed.\n                      National Cholesterol Education Program. Risk assessment tool for estimating your 10-year risk of having a heart attack. http:\/\/hp2010.nhlbihin.net\/atpiii\/calculator.asp (date last accessed 8 June 2012)."},{"key":"r24","unstructured":"No authors listed.\n                      World Health Organization. WHO CVD-Risk Management Package. http:\/\/www.who.int\/cardiovascular_diseases\/priorities\/management\/package\/en\/ (date last accessed 8 June 2012)."},{"key":"r25","unstructured":"No authors listed.\n                      National Institute for Health and Clinical Excellence. Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease, 2008 (CG67). www.nice.org.uk\/guidance\/CG67 (date last accessed 8 June 2012)."},{"key":"r26","unstructured":"No authors listed.\n                      American Heart Association. Heart attack risk assessment. http:\/\/www.heart.org\/HEARTORG\/Conditions\/HeartAttack\/HeartAttackToolsResources\/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp (date last accessed 8 June 2012)."},{"key":"r27","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.00521"},{"key":"r28","unstructured":"No authors listed.\n                      World Health Organization Collaborating Centre for Metabolic Bone Diseases. WHO fracture risk assessment tool. http:\/\/www.shef.ac.uk\/FRAX\/ (date last accessed 8 June 2012)."},{"key":"r29","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1271-9"},{"key":"r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2006.12.063"},{"key":"r31","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-007-0543-5"},{"key":"r32","unstructured":"No authors listed.\n                      National Osteoporosis Foundation. NOF Clinician's Guide to Prevention and Treatment of Osteoporosis, 2010. http:\/\/www.nof.org\/professionals\/clinical-guidelines (date last accessed 8 June 2012)."},{"key":"r33","unstructured":"No authors listed.\n                      International Osteoporosis Foundation. http:\/\/www.iofbonehealth.org\/ (date last accessed 8 June 2012)."},{"key":"r34","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-008-0560-z"},{"key":"r35","unstructured":"Tosi LL, Dell RM.\n                      AAOS. Challenging orthopaedics to reduce osteoporotic hip fractures, 2012. http:\/\/www.aaos.org\/news\/aaosnow\/may09\/research5.asp (date last accessed 8 June 2012)."},{"key":"r36","unstructured":"No authors listed.\n                      National Clinical Guideline Centre. Osteoporosis: fragility fracture risk, 2012. http:\/\/www.nice.org.uk\/nicemedia\/live\/13281\/58077\/58077.pdf (date last accessed 8 June 2012)."},{"key":"r37","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-008-0564-8"},{"key":"r38","first-page":"561","volume":"28","author":"Adami S","year":"2010","journal-title":"Clin Exp Rheumatol"},{"key":"r39","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-12-30"},{"key":"r40","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.123"},{"key":"r41","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-008-0712-1"},{"key":"r42","unstructured":"No authors listed.\n                      WHO Fracture Risk Assessment Tool. FAQ. http:\/\/www.shef.ac.uk\/FRAX\/faq.jsp (date last accessed 8 June 2012)."},{"key":"r43","unstructured":"No authors listed.\n                      International Osteoporosis Foundation. FRAX information and resources. http:\/\/www.iofbonehealth.org\/bonehealth\/frax-information-and-resources (date last accessed 8 June 2012)."},{"key":"r44","unstructured":"No authors listed.\n                      National Institute for Health and Clinical Excellence. Osteoporosis - secondary prevention including strontium ranelate: guidance, 2011 (TA161). http:\/\/www.nice.org.uk\/guidance\/TA161\/Guidance\/pdf (date last accessed 8 June 2012)."},{"key":"r45","unstructured":"No authors listed.\n                      FRAX Release Notes. http:\/\/www.shef.ac.uk\/FRAX\/pdfs\/FRAX_Release_Notes.pdf (date last accessed 17 August 2012)."},{"key":"r46","first-page":"CD001155","volume":"1","author":"Wells GA","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"r47","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1787"},{"key":"r48","doi-asserted-by":"publisher","DOI":"10.1177\/1938640011412953"},{"key":"r49","first-page":"365","volume":"17","author":"Kanis JA","year":"2006","journal-title":"Osteoporosis Int"},{"key":"r50","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2411051290"},{"key":"r51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2009.09.001"},{"key":"r52","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2004.tb06056.x"},{"key":"r53","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-011-1814-8"},{"key":"r54","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1694-9"},{"key":"r55","unstructured":"No authors listed.\n                      Department of Health. Prevention package for older people resources. http:\/\/www.dh.gov.uk\/en\/Publicationsandstatistics\/Publications\/PublicationsPolicyAndGuidance\/DH_103146 (date last accessed 8 June 2012)."},{"key":"r56","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-007-0550-6"},{"key":"r57","unstructured":"No authors listed.\n                      BAILII. England and Wales Court of Appeal (Civil Division) Decisions, 2010. http:\/\/www.bailii.org\/ew\/cases\/EWCA\/Civ\/2010\/346.html (date last accessed 8 June 2012)."},{"key":"r58","unstructured":"No authors listed.\n                      ClinRisk Ltd. 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