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About the ABH Fracture Risk Calculator™ Version 2.1

The ABH 10-Year Fracture Risk Calculator™ (ABH FRC) Version 2.1 published 05/01/2018 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 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.

See our FAQs for more information about the ABH FRC and fracture risk.

If you have more questions about the new 2018 version, call us at 888-266-3015 or email kathleen@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.

Cost Effectiveness

The cost-effectiveness study (Tosteson ANA, et al. Osteoporos Int 2008; 19:437-47) 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.

Treatment Guidelines

Based on the cost-effectiveness study, the National Osteoporosis Foundation has published treatment guidelines summarized below.

Consider pharmacological therapies based on:

  • A vertebral or hip fracture
  • A hip or spine T-score below -2.5
  • Low bone mineral density (BMD) and a FRAX 10-year risk at least 3% for hip or 20% of any of 4-fractures.
  • Patient’s preferences

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.

Return to the Calculator


  1. Ettinger B, Black DM, Dawson-Hughes B, et al. Updated fracture incidence rates for the US version of FRAX. Osteoporos Int 21:25-33, 2010.
  2. Ettinger B, Liu H, Blackwell T, et al. Validation of FRC, a fracture risk assessment tool, in a cohort of older men: The Osteoporotic Fractures in Men Study. J Clin Densitom 2012 [epub ahead of print]
  3. Benichou J. A computer program for estimating individualized probabilities of breast cancer. Comput Biomed Res 1993; 26:373-82.
  4. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-97.
  5. Tosteson ANA, Melton II LJ, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, Lindsay RL. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 2008; 19:437-47.
  6. Dawson-Hughes B, Tosteson ANA, Melton III LJ, Baim S, Favus ML, Khosla S, Lindsay RL. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int 2008; 19:449-58.
  7. Ettinger B, Hillier TA, Pressman AR, Che M, Hanley DA. Simple computer model for calculating 5-year osteoporotic fracture risk in postmenopausal women. J Women’s Health 2005; 14:159-171.
  8. Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR. Which fractures are associated with low appendicular bone mass in elderly women? Study of Osteoporotic Fractures Research Group. Ann Intern Med 1991; 115:837-42.
  9. Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12:24-35.
  10. Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jonsson B. Intervention thresholds for osteoporosis in the UK. Bone 2005; 36: 22-32.
  11. Leslie WD, Lix LM, Johansson H, et al. Does osteoporosis therapy invalidate FRAX for fracture prediction? J Bone Miner Res 2012; doi 10.1002/jbmr.1582 [epub ahead of print]
  12. Siminoski K, Leslie WD, Frame H, et al. Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 2005; 56:178-88.
  13. Hux JE, Naylor CD. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients’ acceptance of treatment? Med Decis Making 1995; 15:152-7.

Revised: 04/15/19
As a service to our readers, American Bone Health provides access to our library of archived content. Please note the date of the last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician4/15/19

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The American Bone Health Fracture Risk Calculator™ estimates fracture risk for women and men over age 45.

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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.