FRAX SCORE UK: WHAT IT IS, HOW IT WORKS, AND HOW A DEXA SCAN IMPROVES ACCURACY

The FRAX score is one of the most widely used tools for predicting fracture risk and identifying people at risk of osteoporosis. Developed by the University of Sheffield, the FRAX tool is used across the UK to estimate the likelihood of major osteoporotic fractures, including hip, spine, forearm, and shoulder fractures. It combines clinical risk factors with (optionally) bone mineral density from a DEXA scan to generate a personalised percentage risk.

This article explains how the FRAX score works, why it matters, how the FRAX score UK version is interpreted, and why combining FRAX with a DEXA scan gives the most accurate assessment.

FRAX (Fracture Risk Assessment Tool) is an online calculator that estimates your 10-year probability of:
– A major osteoporotic fracture
– A hip fracture

It uses your individual risk factors to calculate how likely you are to break a bone in the next decade. The FRAX score UK version is adjusted for local population data, so it reflects the fracture rates observed in the UK.

The FRAX score uses the following clinical risk factors:
– Age
– Sex
– Weight and height (to calculate BMI)
– Previous fracture history
– Parental history of hip fracture
– Smoking status
– Alcohol intake
– Use of steroids (glucocorticoids)
– Rheumatoid arthritis
– Secondary causes of osteoporosis
– Bone mineral density (BMD) — optional but highly recommended

The tool can be used with or without bone density data. However, including a DEXA scan result makes the score far more accurate.

The FRAX score helps clinicians decide:
– Whether a patient has a high fracture risk
– Whether treatment for osteoporosis is needed
– Whether a DEXA scan should be done
– How urgently bone health needs attention

Without a FRAX assessment, fractures often remain unpredictable until they happen. FRAX helps find risk early, before a fracture occurs.

In the UK, FRAX results are generally interpreted using NICE and NOGG guidance. Although thresholds can vary depending on age and clinical judgement, typical categories include:

Low risk
No immediate need for treatment; lifestyle optimisation recommended.

Intermediate risk
A DEXA scan is recommended to refine the risk.

High risk
Consider treatment for osteoporosis and further specialist assessment.

A FRAX score showing a 10-year risk of major fracture or hip fracture above certain treatment thresholds usually indicates that osteoporosis therapy should be considered.

FRAX can be calculated without bone density, but that version is less precise. The best approach is FRAX + DEXA.

A DEXA scan provides bone mineral density (BMD), the most accurate indicator of bone strength. When this is added into the FRAX tool, the resulting score becomes significantly more reliable. Patients at borderline or intermediate risk often change categories once DEXA data is included.

This can mean:
– Low-risk patients avoid unnecessary medication
– High-risk patients are identified earlier
– Treatment decisions become safer and more personalised

FRAX without a DEXA scan is only a screening tool. FRAX with a DEXA scan is a diagnostic-level assessment.

A FRAX score is recommended for:
– Adults over 50
– Post-menopausal women
– Anyone with a history of low-impact fracture
– Long-term steroid users
– Patients with rheumatoid arthritis
– Individuals with strong family history of hip fractures
– People with lifestyle risks such as smoking or high alcohol intake
– Men and women with unexplained height loss or back pain

Anyone unsure about bone health can benefit from a FRAX assessment.

DEXA.LONDON provides clinical-grade DEXA bone density scans that can be used directly in the FRAX tool. Because the FRAX score becomes more accurate with actual BMD values, our scans give the precise data needed for the most reliable UK fracture-risk assessment.

At DEXA.LONDON, your scan is:
– Performed on medical-grade DEXA equipment
– Interpreted by consultant rheumatologists via Medica
– Delivered with clear T-scores and Z-scores
– Ready to input directly into the FRAX score UK calculator
– Suitable for diagnosis, management, and treatment planning

If your FRAX score indicates moderate or high fracture risk, early treatment and lifestyle interventions can significantly reduce the chance of future fractures.

The FRAX score UK is a valuable tool for predicting fracture risk and identifying individuals who may benefit from osteoporosis treatment. Using FRAX alone is helpful, but combining FRAX with a DEXA bone density scan provides the most accurate and clinically meaningful assessment. If you are concerned about your bone health, have risk factors for osteoporosis, or want a complete evaluation, a DEXA scan is the best starting point.

DEXA.LONDON offers fast, reliable bone health scanning to support accurate FRAX scoring and early osteoporosis detection.