Skip to main content

Advertisement

Log in

A brief history of FRAX

  • Review Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

This paper reviews the research programme that went into the development of FRAX® and its impact in the 10 years since its release in 2008.

Introduction

Osteoporosis is defined on the measurement of bone mineral density though the clinical consequence is fracture. The sensitivity of bone mineral density measurements for fracture prediction is low, leading to the development of FRAX to better calculate the likelihood of fracture and target anti-osteoporosis treatments.

Methods

The method used in this paper is literature review.

Results

FRAX, developed over an 8-year period, was launched in 2008. Since the launch of FRAX, models have been made available for 64 countries and in 31 languages covering more than 80% of the world population.

Conclusion

FRAX provides an advance in fracture risk assessment and a reference technology platform for future improvements in performance characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Albright F, Bloomberg E, Smith P (1940) Post-menopausal osteoporosis. Trans Assoc Am Phys 55:298–305

    CAS  Google Scholar 

  2. Albright F, Smith P, Richardson A (1941) Postmenopausal osteoporosis: its clinical features. JAMA 116:2465–2474

    Google Scholar 

  3. Shapira D, Shapira C (1992) Osteoporosis: the evolution of a scientific term. Osteoporos Int 2:164–167

    Google Scholar 

  4. Wylie CD (2010) Setting a standard for a “silent” disease: defining osteoporosis in the 1980s and 1990s. Stud Hist Phil Biol Biomed Sci 41:376–385

    Google Scholar 

  5. Anonymous (1987) Consensus development conference: prophylaxis and treatment of osteoporosis. BMJ 295:914–915

    Google Scholar 

  6. Anonymous (1991) Consensus development conference: prophylaxis and treatment of osteoporosis. JAMA 90:107–110

    Google Scholar 

  7. Anonymous (1993) Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650

    Google Scholar 

  8. Anonymous (2000) Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement 17:1–45

    Google Scholar 

  9. Siris ES, Adler R, Bilezikian J et al (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Kanis JA, McCloskey EV, Harvey NC, Johansson H, Leslie WD (2015) Intervention thresholds and the diagnosis of osteoporosis. J Bone Miner Res 30:1747–1753

    PubMed  Google Scholar 

  11. Nordin BEC (1987) The definition and diagnosis of osteoporosis. Calcif Tissue Int 40:57–58

    CAS  PubMed  Google Scholar 

  12. Mazess RB (1987) Bone density in diagnosis of osteoporosis: thresholds and breakpoints. Calcif Tissue Int 41:117–118

    Google Scholar 

  13. Odvina CV, Wergedal JE, Libanati CR, Schultz EE, Baylink DJ (1988) Relationship between trabecular vertebral body density and fractures: a quantitative definition of spinal osteoporosis. Metabolism 37:221–228

    CAS  PubMed  Google Scholar 

  14. National Osteoporosis Foundation (1989) Clinical indications for bone mass measurements. A report from the Scientific Advisory Board of the National Osteoporosis Foundation. J Bone Miner Res Suppl 2:1–28

    Google Scholar 

  15. Nelson HD, Helfand M (2002) Screening for postmenopausal osteoporosis. Rockville (MD): Agency for Healthcare Research and Quality (US); Available from http://wwwncbinlmnihgov/books/NBK42754/ accessed 28 Feb 2018

  16. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. report of a WHO study group WHO Technical Report Series, 843 Geneva: World Health Organization http://whqlibdocwhoint/trs/who_trs_843pdf accessed 23 June 2018

  17. Kanis JA, Melton LJ III, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    CAS  PubMed  Google Scholar 

  18. Riggs LB, Melton LJ (eds) (1995) Osteoporosis: etiology, diagnosis, and management, 2nd edn. Lippincott-Raven Publishers, Philadelphia

    Google Scholar 

  19. World Health Organization (2003) Prevention and management of osteoporosis: report of a WHO scientific group. WHO Technical Report Series, 921. World Health Organization, Geneva http://whqlibdoc.who.int/trs/who_trs_921.pdf

    Google Scholar 

  20. Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590

    CAS  PubMed  Google Scholar 

  21. Kanis JA, Johnell O, Oden A, Jonsson B, Dawson A, Dere W (2000) Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden. Osteoporos Int 11:120–127

    CAS  PubMed  Google Scholar 

  22. Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Prediction of fracture from low bone mineral density measurements overestimates risk. Bone 26:387–391

    CAS  PubMed  Google Scholar 

  23. Odén A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8:599–603

    PubMed  Google Scholar 

  24. Kanis JA, Johnell O, Odén A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674

    CAS  PubMed  Google Scholar 

  25. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten-year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995

    CAS  PubMed  Google Scholar 

  26. Kanis JA, Johnell O, Oden A, De Laet C, Jonsson B, Dawson A (2002) Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 30:251–258

    CAS  PubMed  Google Scholar 

  27. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112

    PubMed  Google Scholar 

  28. Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26

    CAS  PubMed  Google Scholar 

  29. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42

    CAS  PubMed  Google Scholar 

  30. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473

    CAS  PubMed  Google Scholar 

  31. Jonsson B, Kanis J, Dawson A, Oden A, Johnell O (1999) Effect and offset of effect of treatments for hip fracture on health outcomes. Osteoporos Int 10:193–199

    CAS  PubMed  Google Scholar 

  32. Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244

    PubMed  Google Scholar 

  33. Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427

    CAS  PubMed  Google Scholar 

  34. Siggeirsdottir K, Aspelund T, Johansson H, Gudmundsson EF, Mogensen B, Jonsson BY et al (2014) The incidence of a first major osteoporotic fracture in Iceland and implications for FRAX. Osteoporos Int 25:2445–2451

    CAS  PubMed  Google Scholar 

  35. Lam A, Leslie WD, Lix LM, Yogendran M, Morin SN, Majumdar SR (2014) Major osteoporotic to hip fracture ratios in Canadian men and women with Swedish comparisons: a population-based analysis. J Bone Miner Res 29:1067–1073

    PubMed  Google Scholar 

  36. Hui SL, Slemenda CW, Johnston CC Jr (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Kanis JA, Black D, Cooper C, Dargent P, Dawson-Hughes B, De Laet C et al (2002) A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 13:527–536

    CAS  PubMed  Google Scholar 

  38. De Laet C, Odén A, Johansson H, Johnell O, Jönsson B, Kanis JA (2005) The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int 16:313–318

    PubMed  Google Scholar 

  39. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B et al (2005) Assessment of fracture risk. Osteoporos Int 16:581–589

    PubMed  Google Scholar 

  40. Johansson H, Oden A, Johnell O, Jonsson B, de Laet C, Oglesby A, McCloskey EV, Kayan K, Jalava T, Kanis JA (2004) Optimization of BMD measurements to identify high risk groups for treatment—a test analysis. J Bone Miner Res 19:906–913

    PubMed  Google Scholar 

  41. Kanis JA, Dawson A, Oden A, Johnell O, de Laet C, Jonsson B (2001) Cost-effectiveness of preventing hip fracture in the general female population. Osteoporos Int 12:356–361

    CAS  PubMed  Google Scholar 

  42. Zethraeus N, Ben Sedrine W, Caulin F, Corcaud S, Gathon HJ, Haim M, Johnell O, Jönsson B, Kanis JA, Tsouderos Y, Reginster JY (2002) Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int 13:841–857

    CAS  PubMed  Google Scholar 

  43. Kanis JA, Jonsson B (2002) Economic evaluation of interventions for osteoporosis. Osteoporos Int 13:765–767

    CAS  PubMed  Google Scholar 

  44. Kanis JA, Johnell O, Oden A, De Laet C, Oglesby A, Jönsson B (2002) Intervention thresholds for osteoporosis. Bone 31:26–31

    CAS  PubMed  Google Scholar 

  45. Zethraeus N, Borgström F, Ström O, Kanis JA, Jönsson B (2007) Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int 18:9–23

    CAS  PubMed  Google Scholar 

  46. De Laet C, Kanis JA, Oden A, Johansson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338

    PubMed  Google Scholar 

  47. Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ III, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    PubMed  Google Scholar 

  48. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    CAS  PubMed  Google Scholar 

  49. Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Eisman JA et al (2004) A family history of fracture and fracture risk: a meta-analysis. Bone 35:1029–1037

    CAS  PubMed  Google Scholar 

  50. Kanis JA, Johnell O, Oden A, Johansson H, De Laet C, Eisman JA et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162

    CAS  PubMed  Google Scholar 

  51. Kanis JA, Johansson H, Oden A, Johnell O, De Laet C, Melton LJ et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    PubMed  Google Scholar 

  52. Kanis JA, Johansson H, Johnell O, Oden A, De Laet C, Eisman JA et al (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16:737–742

    PubMed  Google Scholar 

  53. Kanis JA, on behalf of the World Health Organization Scientific Group (2008b) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. https://www.sheffield.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf Accessed 12 May 2018

  54. Kanis JA, Oden A, Johnell O (2001) Acute and long-term increase in fracture risk after hospitalisation for stroke. Stroke 32:702–706

    CAS  PubMed  Google Scholar 

  55. Johnell O, Odén A, De Laet C, Garnero P, Delmas PD, Kanis JA (2002) Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int 13:523–526

    CAS  PubMed  Google Scholar 

  56. Bagger YZ, Tanko LB, Alexandersen P, Hansen HB, Mollgaard A, Ravn P, Qvist P, Kanis JA, Christiansen C (2004) Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures. The PERF study. Bone 34:728–735

    CAS  PubMed  Google Scholar 

  57. Kanis JA, Johnell O, Oden A, De Laet C, de Terlizzi F (2005) Ten-year probability of clinical vertebral fractures according to phalangeal quantitative ultrasonography. Osteoporos Int 16:1065–1070

    CAS  PubMed  Google Scholar 

  58. McCloskey EV, Johansson H, Kanis JA, Odén A, Harvey N, Bauer D, Hans D, Kaptoge S, Khaw KT, Krieg M-A, Kwok T, Marin F, Orwoll E, Reeve J, Glueer C (2015) Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis. Osteoporos Int 26:1979–1987

    CAS  PubMed  Google Scholar 

  59. Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2012) FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 27:301–308

    PubMed  Google Scholar 

  60. McCloskey EV, Kanis JA, Odén A, Johansson H, Diez-Perez A, Eisman JA et al (2012) A meta-analysis of the association between falls and hip fracture risk. Osteoporos Int 23(Suppl 2):S80–S81

    Google Scholar 

  61. McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340

    CAS  PubMed  Google Scholar 

  62. Kanis JA, Johansson H, Oden A, De Laet C, Johnell O, Eisman JA et al (2005) A meta-analysis of milk intake and fracture risk: low utility for case finding. Osteoporos Int 16:799–804

    PubMed  Google Scholar 

  63. Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD (2012) FRAX® with and without BMD. Calcif Tissue Int 90:1–13

    CAS  PubMed  Google Scholar 

  64. Roux C, Reginster J-Y, Fechtenbaum J et al (2006) Vertebral fracture with reduction with strontium ranelate in women with postmenopausal osteoporosis is independent of baseline risk factors. J Bone Miner Res 21:536–542

    CAS  PubMed  Google Scholar 

  65. Marcus R, Wang O, Satterwhite J et al (2003) The skeletal response to teriparatide is largely independent of age, initial bone mineral density and prevalent vertebral fractures in postmenopausal women with osteoporosis. J Bone Miner Res 18:18–23

    CAS  PubMed  Google Scholar 

  66. Kanis JA, Barton I, Johnell O (2005) Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int 16:475–482

    CAS  PubMed  Google Scholar 

  67. Kanis JA, Johnell O, Black DM et al (2003) Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone 33:293–300

    CAS  PubMed  Google Scholar 

  68. Johnell O, Kanis JA, Black DM et al (2004) Association between baseline risk factors and vertebral fracture risk in the Multiple Outcomes of Raloxifene Evaluation (MORE) study. J Bone Miner Res 19:764–772

    CAS  PubMed  Google Scholar 

  69. McCloskey EV, Selby P, Davies M et al (2004) Clodronate reduces vertebral fracture risk in women with post-menopausal or secondary osteoporosis: results of a double-blind placebo-controlled 3-year study. J Bone Miner Res 19:728–736

    CAS  PubMed  Google Scholar 

  70. Kanis JA, Johnell O, on behalf of the Committee of Scientific Advisors of the International Osteoporosis Foundation (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:229–238

    CAS  PubMed  Google Scholar 

  71. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046

    CAS  PubMed  Google Scholar 

  72. Borgström F, Johnell O, Kanis JA, Jönsson B, Rehnberg C (2006) At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis. Osteoporos Int 17:1459–1471

    PubMed  Google Scholar 

  73. Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C et al (2005) Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 16:6–14

    PubMed  Google Scholar 

  74. Borgström F, Johnell O, Jönsson B, Zethraeus N, Sen SS (2004) Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden. Bone 34:1064–1071

    PubMed  Google Scholar 

  75. Johnell O, Jönsson B, Jönsson L, Black D (2003) Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314

    PubMed  Google Scholar 

  76. Borgström F, Carlsson A, Sintonen H, Boonen S, Haentjens P, Burge R, Johnell O, Jönsson B, Kanis JA (2006) The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective. Osteoporos Int 17:996–1007

    PubMed  Google Scholar 

  77. Kanis JA, Borgstrom F, Johnell O, Jonsson B (2004) Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 15:862–871

    CAS  PubMed  Google Scholar 

  78. Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jönsson B (2005) Intervention thresholds for osteoporosis in the UK. Bone 36:22–32

    PubMed  Google Scholar 

  79. Borgström F, Johnell O, Kanis JA, Oden A, Sykes D, Jönsson B (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22:1153–1165

    PubMed  Google Scholar 

  80. Zethraeus N, Borgström F, Jönsson B, Kanis J (2005) Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: results based on the Women’s Health Initiative randomized controlled trial. Int J Technol Assess Health Care 21:433–441

    PubMed  Google Scholar 

  81. Borgström F, Jönsson B, Ström O, Kanis JA (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17:1781–1793

    PubMed  Google Scholar 

  82. Ström O, Jönsson B, Kanis JA (2013) Intervention thresholds for denosumab in the UK using a FRAX®-based cost-effectiveness analysis. Osteoporos Int 24:1491–1502

    PubMed  Google Scholar 

  83. Jönsson B, Ström O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA (2011) Cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22:967–982

    PubMed  Google Scholar 

  84. Jönsson B, Ström O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA (2012) Comment on: Cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 23:2063–2065

    PubMed  Google Scholar 

  85. Zethraeus N, Ström O, Borgström F, Kanis JA, Jönsson B (2008) The cost-effectiveness of the treatment of high risk women with osteoporosis, hypertension and hyperlipidaemia in Sweden. Osteoporos Int 19:819–827

    CAS  PubMed  Google Scholar 

  86. Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, National Osteoporosis Foundation Guide Committee et al (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Lippuner K, Johansson H, Kanis JA, Rizzoli R (2010) FRAX® assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–390

    CAS  PubMed  Google Scholar 

  88. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, the National Osteoporosis Guideline Group (2008) Case finding for the management of osteoporosis with FRAX®—assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408 Erratum 2009 Osteoporos Int 20, 499–502

    CAS  PubMed  Google Scholar 

  89. Socialstyrelsen (2010) Nationella riktlinjer för rörelseorganens sjukdomar 2010 – stöd för styrning och ledning. Preliminär version. Artikelnr 2010-11-15. Published at www.socialstyrelsen.se

  90. FORE; Foundation for Osteoporosis Research and Education (2012) The FORE 10-year fracture risk calculator https://riskcalculator.fore.org/default.aspx accessed 9 Sept 2017

  91. Compston J, Cooper A, Cooper C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, Wilkins M, on behalf of the National Osteoporosis Guideline Group (NOGG) (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108

    CAS  PubMed  Google Scholar 

  92. National Osteoporosis Foundation (2008) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, D C, pp 1–36

  93. Dawson-Hughes B, Looker AC, Tosteson ANA, Johansson H, Kanis JA, Melton LJ III (2010) The potential impact of new National Osteoporosis Foundation guidance on treatment patterns. Osteoporos Int 21:41–52

    CAS  PubMed  Google Scholar 

  94. Kanis JA, Adams J, Borgström F, Cooper C, Jönsson B, Preedy D et al (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15

    CAS  PubMed  Google Scholar 

  95. Royal College of Physicians (1999) Osteoporosis: clinical guidelines for the prevention and treatment. RCP, London

    Google Scholar 

  96. Kanis JA, Harvey NC, Cyrus Cooper C, Johansson H, Odén A, McCloskey EV et al (2016) A systematic review of intervention thresholds based on FRAX. A report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos 11(1):25. https://doi.org/10.1007/s11657-016-0278-z

    Article  PubMed  PubMed Central  Google Scholar 

  97. Clark P, Lavielle P, Franco-Morina F, Ramirez E, Salmeron J, Kanis JA, Cummings SR (2005) Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age. A population-based study. Osteoporos Int 16:2025–2030

    PubMed  Google Scholar 

  98. Lesnyak O, Ershova O, Belova K, Gladkova E, Sinitsina O, Ganert O, Marina Romanova M, Vitalij Khodirev V, Johansson H, McCloskey E, Kanis JA (2012) Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Arch Osteoporos 7:67–73. https://doi.org/10.1007/s11657-012-0082-3

    Article  PubMed  Google Scholar 

  99. Lesnyak O, Sahakyan S, Zakroyeva A, Bilezikian JP, Hutchings N, Galstyan R et al (2017) Epidemiology of fractures in Armenia: development of a country-specific FRAX model and comparison to its designated surrogate country. Arch Osteoporos 12:98. https://doi.org/10.1007/s11657-017-0392-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Ramanau H, Chernyanin I, Rudenka E, Lesnyak O, Zakroyeva A, Bilezikian JP, Johansson H, Harvey NC, McCloskey E, Kanis JA (2018) Epidemiology of hip fracture in Belarus: development of a country-specific FRAX model and its comparison to neighbouring countries. Arch Osteoporos 13(1):42. https://doi.org/10.1007/s11657-018-0454-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Ettinger B, Black D, Dawson-Hughes B, Pressman AR, Melton LJ III (2009) Updated fracture incidence rates for the US version of FRAX®. Osteoporos Int 21:25–33

    PubMed  PubMed Central  Google Scholar 

  102. Tuzun S, Eskiyurt N, Akarırmak U, Sarıdoğan M, Senocak M, Johansson H et al (2012) Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 23:949–955

    CAS  PubMed  Google Scholar 

  103. Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H (2015) Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int 26:2243–2248

    PubMed  Google Scholar 

  104. Clark P, Denova-Gutierrez E, Zerbini C, Sanchez A, Messina O, Jaller JJ, Campusano C, González J, Riera G, Johansson H, Kanis JA (2017) FRAX-based intervention and assessment thresholds in seven Latin American countries. Osteoporos Int 29:707–715

    PubMed  Google Scholar 

  105. Johansson H, Kanis JA, McCloskey EV, Odén A, Devogelaer J-P, Kaufman J-M, Neuprez A, Hiliigsmann M, Bruyere O, Reginster JY (2011) A FRAX® model for the assessment of fracture probability in Belgium. Osteoporos Int 22:453–461

    CAS  PubMed  Google Scholar 

  106. Silva DMW, Borba VZC, Kanis JA (2017) Building FRAX Brazil: clinical risk factors and applicability of this tool in Joinville, Southern Brazil. Arch Osteoporos 9;12(1):111. doi: https://doi.org/10.1007/s11657-017-0405-5

  107. Zerbini CAF, Szejnfeld VL, Abergaria BH, McCloskey EV, Johansson H, Kanis JA (2015) Incidence of hip fracture in Brazil and the development of a FRAX model. Arch Osteoporos 10(1):224. https://doi.org/10.1007/s11657-015-0224-5

    Article  CAS  PubMed  Google Scholar 

  108. Leslie WD, Lix LM, Langsetmo L, Berger C, Goltzman D, Hanley DA, Adachi JD, Johansson H, Oden A, McCloskey EV, Kanis JA (2011) Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int 22:817–827

    CAS  PubMed  Google Scholar 

  109. Stepan JJ, Vaculik J, Pavelka K, Zofka J, Johansson H, Kanis JA (2012) Hip fracture incidence between years 1981 and 2009 in the Czech Republic as a basis of the country-specific FRAX model. Calcif Tissue Int 90:365–372

    CAS  PubMed  Google Scholar 

  110. Jaller-Raad JJ, Jaller-Char JJ, Lechuga-Ortiz JA, Navarro-Lechuga E, Johansson H, Kanis JA (2013) Incidence of hip fracture in Barranquilla, Colombia and the development of a Colombian FRAX model. Calcif Tissue Int 93:15–22

    CAS  PubMed  Google Scholar 

  111. Sund R, Honkanen R, Johansson H, Oden A, McCloskey EV, Kanis JA, Kröger H (2014) Evaluation of the FRAX model for the prediction of hip fractures in Kuopio, Finland. Calcif Tissue Int 95:39–45

    CAS  PubMed  Google Scholar 

  112. Tsang SWY, Kung AWC, Kanis JA, Johansson H, Oden A (2009) Ten-year fracture probability in Hong Kong southern Chinese according to age and BMD femoral neck T-scores. Osteoporos Int 20:1939–1945

    CAS  PubMed  Google Scholar 

  113. McGowan B, Kanis JA, Johansson H, Silke C, Whelan B (2013) Development and use of FRAX in the management of osteoporosis in Ireland. Arch Osteoporos 8(1–2):146. https://doi.org/10.1007/s11657-013-0146-z

    Article  CAS  PubMed  Google Scholar 

  114. Piscitelli P, Brandi ML, Chitano G, Johannson H, Kanis JA, Black DM (2013) Updated fracture incidence rates for the Italian version of FRAX®. Osteoporos Int 24:859–866

    CAS  PubMed  Google Scholar 

  115. Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, Johansson H, Kanis JA (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX™). Osteoporos International 19:429–448

    CAS  Google Scholar 

  116. Johansson H, Azizieh F, Harvey NC, McCloskey E, Kanis JA (2017) FRAX- vs. T-score-based intervention thresholds for osteoporosis. Osteoporos Int 28:3099–3105

    CAS  PubMed  PubMed Central  Google Scholar 

  117. Lalmohamed A, Welsing PMJ, Lems WF, Jacobs JWG, Kanis JA, Johansson H, De Boer A, De Vries F (2012) Calibration of FRAX ® 3.1 to the Dutch population with data on the epidemiology of hip fractures. Osteoporos Int 23:861–869

    CAS  PubMed  Google Scholar 

  118. Czerwiński E, Kanis JA, Osieleniec J, Kumorek A, Milert A, Johansson H et al (2011) Evaluation of FRAX to characterize fracture risk in Poland. Osteoporos Int 22:2507–2512

    PubMed  Google Scholar 

  119. Marques A, Mota A, Canhão H, Romeu JC, Machado P, Ruano A et al (2013) A FRAX® model for the estimation of osteoporotic fracture probability in Portugal. Acta Reumatol Port 38:104–112

    PubMed  Google Scholar 

  120. Grigorie D, Sucaliuc A, Johansson H, Kanis JA, McCloskey E (2013) Incidence of hip fracture in Romania and the development of a Romanian FRAX model. Calcif Tissue Int 92:429–436

    CAS  PubMed  Google Scholar 

  121. Johansson H, Kanis JA, Lunggren O, Ström O, Svensson O, Mellström D (2011) FRAX – model för att beräkna 10-årsrisken för fraktur. [FRAX—model for 10-year fracture risk assessment. Support in the treatment of osteoporosis, according to preliminary Swedish guidelines]. Läkartidningen 108:336–339

    PubMed  Google Scholar 

  122. Lippuner K, Johansson H, Rizzoli R, Kanis JA (2009) Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 20:1131–1140

    CAS  PubMed  Google Scholar 

  123. Tuzun S, Eskiyurt N, Akarırmak U, Sarıdoğan M, Johansson H, Kanis JA, the Turkish Osteoporosis Society (2012) The impact of FRAX-based intervention thresholds in Turkey: the FRAX-TURK study. Arch Osteoporos 7:229–235

    PubMed  Google Scholar 

  124. Povoroznyuk VV, Grygorieva NV, Kanis JA, McCloskey EV, Johansson H, Harvey NC, Korzh MO, Strafun SS, Vaida VM, Klymovytsky FV, Vlasenko RO, Forosenko VS (2017) Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos 12(1):53. https://doi.org/10.1007/s11657-017-0343-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Looker AC, Dawson-Hughes B, Tosteson ANA, Johansson H, Kanis JA, Melton LJ III (2010) Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance. Osteoporos Int 22:541–549

    PubMed  Google Scholar 

  126. Committee for Medicinal Products for Human Use (CHMP) (2006) Guideline on the evaluation of medicinal products in the treatment of primary osteoporosis. London: CHMP; Ref CPMP/EWP/552/95Rev.2

  127. Kanis JA, Jönsson B, Odén A, McCloskey EV (2011) A meta-analysis of the effect of strontium ranelate on the risk of vertebral and non-vertebral fracture in postmenopausal osteoporosis and the interaction with FRAX®. Osteoporos Int. 22: 2347-2355 with erratum. Osteoporos Int 22:2357–2358

    Google Scholar 

  128. Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Bazedoxifene reduces vertebral and clinical fractures in postmenopausal women at high risk assessed with FRAX®. Bone 44:1049–1054

    CAS  PubMed  Google Scholar 

  129. Kanis JA, Johansson H, Oden A, McCloskey EV (2010) A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX®. Bone 47:729–735

    CAS  PubMed  Google Scholar 

  130. McCloskey EV, Johansson H, Oden A, Vasireddy S, Kayan K, Pande K et al (2009) Ten-year fracture probability identifies women who will benefit from clodronate therapy—additional results from a double-blind, placebo-controlled randomised study. Osteoporos Int 20:811–817

    CAS  PubMed  Google Scholar 

  131. Harvey NC, Kanis JA, Odén A, Burge RT, Mitlak BH, Johansson H, McCloskey EV (2015) FRAX and the effect of teriparatide on vertebral and non-vertebral fracture. Osteoporos Int 26:2347–2353

    CAS  PubMed  PubMed Central  Google Scholar 

  132. Harvey NC, Kanis JA, Odén A, Nakamura T, Shiraki M, Sugimoto T, Kuroda T, Johansson H, McCloskey EV (2015) Efficacy of weekly teriparatide does not vary by baseline fracture probability calculated using FRAX. Osteoporos Int 26:2347–2354

    CAS  PubMed  PubMed Central  Google Scholar 

  133. McCloskey EV, Johansson H, Oden A, Harvey NC, Jiang H, Modin S et al (2017) The effect of abaloparatide-SC on fracture risk is independent of baseline FRAX fracture probability: a post hoc analysis of the ACTIVE study. J Bone Miner Res 32:1625–1631

    CAS  PubMed  Google Scholar 

  134. McCloskey EV, Johansson H, Oden A, Austin M, Siris E, Wang A et al (2012b) Denosumab reduces the risk of all osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX®. J Bone Miner Res 27:1480–1486

    CAS  PubMed  Google Scholar 

  135. Donaldson MG, Palermo L, Ensrud KE, Hochberg MC, Schousboe JT, Cummings SR (2012) Effect of alendronate for reducing fracture by FRAX score and femoral neck bone mineral density: the Fracture Intervention Trial. J Bone Miner Res 27:1804–1810

    CAS  PubMed  Google Scholar 

  136. Shepstone L, Lenaghan E, Cooper C et al (2018) Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet 391(10122):741–747

    PubMed  Google Scholar 

  137. McCloskey E, Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong R et al (2018) Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures—a post hoc analysis from the SCOOP study. J Bone Miner Res 33:1020–1026

    CAS  PubMed  Google Scholar 

  138. Ström O, Borgström F, Kleman M et al (2010) FRAX and its applications in health economics—cost-effectiveness and intervention thresholds using bazedoxifene in a Swedish setting as an example. Bone 47:430–437

    PubMed  Google Scholar 

  139. National Institute for Health and Care Excellence (2017) TA464: bisphosphonates for treating osteoporosis. Technology appraisal guidance 464. National Institute for Health and Care Excellence, London nice.org.uk/guidance/ta464

    Google Scholar 

  140. Ström O, Borgström F, Kanis JA, Jönsson B (2009) Incorporating adherence into health economic modelling of osteoporosis. Osteoporos Int 20:23–34 Erratum in: Osteoporos Int 20: 35

    PubMed  Google Scholar 

  141. Borgström F, Jonsson E, Harvey N et al (2018) Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting. Osteoporos Int WCO abstract in press

  142. Turner DA, Khioe RFS, Shepstone L, Lenaghan E, Cooper C, Gittoes N et al (2018) The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study. J Bone Miner Res 33:845–851

    PubMed  Google Scholar 

  143. Kanis JA, Hans D, Cooper C et al (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:2395–2411

    CAS  PubMed  Google Scholar 

  144. Johansson H, Odén A, McCloskey EV, Kanis JA (2014) Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures. Osteoporos Int 25:235–241

    CAS  PubMed  Google Scholar 

  145. Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000

    PubMed  Google Scholar 

  146. Hans DB, Kanis JA, Baim S et al (2011) Joint official positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. Executive summary of the 2010 position development conference on interpretation and use of FRAX® in clinical practice. J Clin Densitom 14:171–180

    PubMed  Google Scholar 

  147. Kanis JA, Johansson H, Oden A, McCloskey EV (2011) Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22:809–816

    CAS  PubMed  Google Scholar 

  148. Johansson H, Kanis JA, Odén A et al (2014) Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women: a meta-analysis of international cohorts. Calcif Tissue Int 95:428–435

    CAS  PubMed  PubMed Central  Google Scholar 

  149. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22:839–847

    CAS  PubMed  Google Scholar 

  150. Leslie WD, Johansson H, Kanis JA et al (2014) Lumbar spine texture enhances 10-year fracture probability assessment. Osteoporos Int 25:2271–2277

    CAS  PubMed  Google Scholar 

  151. Leslie WD, Shevroja E, Johansson H et al (2018) Risk-equivalent T-score adjustment using lumbar spine trabecular bone score (TBS): the Manitoba BMD Registry. Osteoporos Int 29:751–758

    CAS  PubMed  PubMed Central  Google Scholar 

  152. McCloskey EV, Oden A, Harvey NC et al (2015) Adjusting fracture probability by trabecular bone score. Calcif Tissue Int 96:500–509

    CAS  PubMed  Google Scholar 

  153. McCloskey EV, Odén A, Harvey NC et al (2016) A meta-analysis of trabecular bone score in fracture risk prediction and its dependence on FRAX. J Bone Miner Res 31:940–948

    PubMed  Google Scholar 

  154. Leslie WD, Lix LM, Morin SN et al (2015) Adjusting hip fracture probability in men and women using hip axis length: the Manitoba Bone Density Database. J Clin Densitom 19:326–331

    PubMed  Google Scholar 

  155. Masud T, Binkley N, Boonen S, Hannan MT, on behalf of the FRAX Position Conference members (2011) Can falls and frailty be used in FRAX? J Clin Densitom 14:194–204

    PubMed  Google Scholar 

  156. Johansson H, Odén A, Lorentzon M et al (2015) Is the Swedish FRAX model appropriate for immigrants to Sweden? Osteoporos Int 26:2617–2622

    CAS  PubMed  Google Scholar 

  157. Leslie WD, Rubin MR, Schwartz AZ, Kanis JA (2012) Perspective: diabetes and bone. J Bone Miner Res 27:2231–2237

    PubMed  Google Scholar 

  158. Leslie WD, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D (2018) Comparison of methods for improving fracture risk assessment in diabetes: the Manitoba BMD Registry. J Bone Miner Res, Submitted Feb 2018

  159. Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractures scores. BMJ 339:b4229

    PubMed  PubMed Central  Google Scholar 

  160. Chen P, Krege JH, Adachi JD et al (2009) Vertebral fracture status and the World Health Organization risk factors for predicting osteoporotic fracture risk. J Bone Miner Res 24:495–502

    PubMed  Google Scholar 

  161. Ensrud KE, Lui LY, Taylor BC et al (2009) A comparison of prediction models for fractures in older women: is more better? Arch Int Med 169:2087–2094

    Google Scholar 

  162. Donaldson MG, Palermo L, Schousboe JT, Ensrud KE, Hochberg MC, Cummings SR (2009) FRAX and risk of vertebral fractures: the fracture intervention trial. J Bone Miner Res 24:1793–1799

    PubMed  Google Scholar 

  163. Sornay-Rendu E, Munoz F, Delmas PD, Chapurlat RD (2010) The FRAX® tool in French women: how well does it describe the real incidence of fracture in the OFELY cohort. J Bone Miner Res 25:2101–2107

    PubMed  Google Scholar 

  164. Pluskiewicz W, Adamczyk P, Franek E et al (2010) Ten-year probability of osteoporotic fracture in 2012 Polish women assessed by FRAX and nomogram by Nguyen et al.—conformity between methods and their clinical utility. Bone 46:1661–1667

    CAS  PubMed  Google Scholar 

  165. Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV (2010) Prognosis of fracture: evaluation of predictive accuracy of the FRAX™ algorithm and Garvan nomogram. Osteoporos Int 21:863–871

    CAS  PubMed  Google Scholar 

  166. Tremollieres FA, Pouilles JM, Drewniak N, Laparra J, Ribot CA, Dargent-Molina P (2010) Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: sensitivity of the WHO FRAX tool. J Bone Miner Res 25:1002–1009

    PubMed  Google Scholar 

  167. Bolland MJ, Siu AT, Mason BH et al (2011) Evaluation of the FRAX and Garvan fracture risk calculators in older women. J Bone Miner Res 26:420–427

    PubMed  Google Scholar 

  168. Hillier TA, Cauley JA, Rizzo JH (2011) The WHO absolute fracture risk models (FRAX): do clinical risk factors improve fracture prediction in older women without osteoporosis? J Bone Miner Res 26:1774–1782

    PubMed  Google Scholar 

  169. Tamaki J, Iki M, Kadowaki E, Sato Y et al (2011) The clinical utility of FRAX to discriminate fracture status in men and women with chronic kidney disease. Osteoporos Int 25:71–76

    Google Scholar 

  170. Azagra R, Roca G, Encabo G et al (2012) FRAX® tool, the WHO algorithm to predict osteoporotic fractures: the first analysis of its discriminative and predictive ability in the Spanish FRIDEX cohort. BMC Musculoskelet Disord 13:204. https://doi.org/10.1186/1471-2474-13-204

    Article  PubMed  PubMed Central  Google Scholar 

  171. Leslie WD, Lix LM (2014) Comparison between various fracture risk assessment tools. Osteoporos Int 25:1–21

    CAS  PubMed  Google Scholar 

  172. National Clinical Guideline Centre (2012) Osteoporosis: fragility fracture risk. Osteoporosis: assessing the risk of fragility fracture. Short clinical guideline—CG146 evidence and recommendations’ August 2012. Published by the National Clinical Guideline Centre by the Royal College of Physicians, London

    Google Scholar 

  173. Kanis JA, Oden A, Johansson H, McCloskey E (2012) Pitfalls in the external validation of FRAX. Osteoporos Int 23:423–431

    CAS  PubMed  Google Scholar 

  174. Marques A, Ferreira RJO, Santos E, Loza E, Carmona L, Pereira da Silva JA (2015) The accuracy of osteoporotic fracture risk prediction tools: a systematic review and meta-analysis. Ann Rheum Dis 74:1958–1967

    PubMed  Google Scholar 

  175. Nayak S, Edwards DL, Saleh AA, Greenspan SL (2015) Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporos Int 26:1543–1554

    CAS  PubMed  PubMed Central  Google Scholar 

  176. Järvinen TL, Jokihaara J, Guy P, Alonso-Coello P, Collins GS, Michaëlsson K, Sievänen H (2014) Conflicts at the heart of the FRAX tool. CMAJ 186:165–167

    PubMed  PubMed Central  Google Scholar 

  177. Järvinen TL, Michaëlsson K, Aspenberg P, Sievänen H (2015) Osteoporosis: the emperor has no clothes. J Int Med 277:662–673

    Google Scholar 

  178. Järvinen TL, Michaëlsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, Musini V, Erviti J, Gorricho J, Wright JM, Sievänen H (2015) Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 350:h2088. https://doi.org/10.1136/bmj.h2088

    Article  PubMed  Google Scholar 

  179. Compston JE, Cooper A, Cooper C et al (2008) Drugs for pre-osteoporosis: an example of prejudice-based medicine? BMJ 336:126. https://doi.org/10.1136/bmj.39435.656250.AD

    Article  Google Scholar 

  180. Compston J (2015) Overdiagnosis of osteoporosis: fact or fallacy? Osteoporos Int 26:2051

    CAS  PubMed  Google Scholar 

  181. Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N, The National Osteoporosis Guideline Group (NOGG) (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12:43. https://doi.org/10.1007/s11657-017-0324-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  182. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y, on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57

    CAS  PubMed  Google Scholar 

  183. Javaid K (2015) Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 350:h2088. https://doi.org/10.1136/bmj.h2088

    Article  Google Scholar 

  184. Ford N, Norris SL, Hill SR (2016) Clarifying WHO’s position on the FRAX® tool for fracture prediction. Bull World Health Organ 94:862

    PubMed  PubMed Central  Google Scholar 

  185. Gollogly L, Susan Norris S, Ford N (2018) Correcting the record on a fracture risk assessment tool. N Engl J Med 378:867–868

    PubMed  Google Scholar 

  186. Kanis JA (2000) Proposal for renewal of designation as a WHO collaborating Centre. University of Sheffield https://www.sheffield.ac.uk/FRAX/pdfs/WHO_2000.pdf accessed 5 may 2018

  187. World Health Organization (2007) WHO scientific group on the assessment of osteoporosis at primary health care level. Summary Meeting Report Brussels, Belgium, 5–7 May 2004 http://www.who.int/chp/topics/Osteoporosis.pdf?ua=1 Accessed 4 Mar 2018

  188. Kanis JA, the WHO study group (1994) Assessment of fracture risk and its application to postmenopausal osteoporosis: synopsis of a WHO report. Osteoporos Int 4:368–381

    CAS  PubMed  Google Scholar 

  189. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475

    CAS  PubMed  Google Scholar 

  190. Anonymous (2005) WHO statement on hormonal contraception and bone health. Wkly Epidemiol Rec 80:302–304

    Google Scholar 

  191. Retraction Watch (2017) WHO asks dozens of journals to correct papers on diagnostic tool developed by former collaborators. https://retractionwatch.com/2017/11/16/asks-dozens-journals-correct-papers-diagnostic-tool-developed-former-collaborators/ accessed 19th November 2017

  192. Brown T (2016) In defence of evidence, expertise, and facts. BMJ 355:i6467

    PubMed  Google Scholar 

  193. National Institute for Health and Care Excellence (2012) NICE clinical guideline 146. Osteoporosis: assessing the risk of fragility fracture. London, UK. https://www.nice.org.uk/guidance/cg146, Accessed 18 Jan 2017

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John A. Kanis.

Ethics declarations

Conflict of interests

All authors have contributed to the development of FRAX but have no financial interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kanis, J.A., Johansson, H., Harvey, N.C. et al. A brief history of FRAX. Arch Osteoporos 13, 118 (2018). https://doi.org/10.1007/s11657-018-0510-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-018-0510-0

Keywords

Navigation