A comparison of fracture risk assessment tools

Abstract Intuitively, it makes more sense to intervene in patients at high absolute risk than in patients whose risk of fracture is low. Clinical risk assessment tools are intended to facilitate this discussion with patients and are based upon the premise that prediction based upon multiple risk factors is more accurate than prediction based upon a single risk factor, including bone mineral density (BMD). Easily identified clinical risk factors (such as age, sex, and previous fracture) are associated with fracture risk independently of BMD. Several fracture risk assessment tools have been developed to estimate absolute fracture risk from these clinical factors. The clinical fracture risk assessment tools which have been most studied to date include FRAX®, the QFractureScore, and the Garvan Fracture Risk Calculator. This chapter reviews the characteristics of these tools, their strengths and limitations, incorporation into clinical practice guidelines, and prospects for improvements.