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The American Bone Health Fracture Risk Calculator™ (ABH FRC) Version 3.0, published 03/04/2021, estimates 10-year fracture risk for postmenopausal women and men age 45 and older who are not receiving treatment for osteoporosis. The ABH FRC is a valuable tool for use in discussions between patients and their health care provider about the prevention and treatment of osteoporosis. The tool has a patient friendly graphic display of the risk results comparing it to expected risk, and categorizing risk as low, medium, or high.
Visit the Frequently Asked Questions section for more information about the bone health and fracture risk.
If you have more questions about the calculator, call us at 888-266-3015 or email info@americanbonehealth.org
The ABH FRC closely aligns to the United States FRAX™ from the World Health Organization, with few exceptions. The ABH FRC and FRAX model use the same input variables, the same base fracture rates, and the same relative risks (multipliers).2 Both can be applied to men and 4 different ethnicities. Both output the 10-year risk of hip and any one of 4 fractures (hip, wrist, humerus, clinical spine). Thus, users of these models should get very similar, but not identical results.
Because the ABH FRC does not build in the same “mortality offset” found in FRAX, ABH FRC will yield higher rates of fracture in individuals with conditions associated with shorter life expectancy (e.g. age over 80 years, very low BMD, very low BMI, etc.) Our assumption is that individuals who use the ABH FRC will live an additional 10 years.
Both the ABH FRC and FRAX™ models aim to keep the model data entry simple and in an easily understood format by using risk factors whose individual contributions to fracture risk have been estimated in large epidemiologic studies using multivariable models; the risk factors are the same as those used in cost-effectiveness analyses.5
This model is based on fracture rates in untreated women and does not account for osteoporosis treatment effects. Estimates of the fracture risk reduction from regular bisphosphonate therapy are in the order of 25–35%.5,6,10 Recently, Leslie et al11, on the basis of a large population study, conclude that “the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis.” In that study, bisphosphonate use did not substantially change the categorization of women in the population to low, medium, or high risk.
“Two versions of this risk tool—[FRAX and FRC]—have similar AUROCs [area under the receiver operating characteristics], but alternative assessments indicate that addition of BMD improves performance. Multiple methods should be used to evaluate risk tool performance with less reliance on AUROC alone.”14
“We conclude that the FRC calibrates well with hip and major osteoporotic fractures observed among older men. Further, addition of BMD to the fracture risk calculation improves the tool’s performance.”2
“The FRC tool can be applied to assess fracture risk in large populations using data from administrative databases. Despite some underestimation, this relatively simple tool may assist targeting of at-risk populations for more complete fracture risk assessment.“14
The cost-effectiveness study (Tosteson ANA, et al. Osteoporos Int 2008; 19:437–47 5) was based on Rochester MN population fracture rates and used the WHO model for fracture risks. The primary outcome studied was hip fracture with a secondary outcome as any one of four fractures (vertebra, femur, wrist, or humerus). The researchers looked at a 10-year window and assumed a 35% risk reduction from treatment. Based on those assumptions, the authors determined that HIGH RISK was defined as a 3% chance of hip fracture in the next 10 years or a 20% chance of any of four other fractures.
Based on the cost-effectiveness study, the National Osteoporosis Foundation has published treatment guidelines summarized below.
Consider pharmacological therapies based on:
Bruce Ettinger, MD has published an extensive description of the FRC and FRAX models and their use in clinical practice in the journal Menopause, September 2008, volume 15, issue 5, pp. 1023-1026 16.
Ettinger, B. A personal perspective on fracture risk assessment tools, Menopause, 15:5, 2008, 1023–1026. doi: 10.1097/gme.0b013e31817f3e4d
Revised: 04/15/20; 9/28/20.
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