What are the recommended tools for assessing fracture risk in postmenopausal women?

Recommended tools for assessing fracture risk in postmenopausal women include the FRAX® and QFracture® risk assessment calculators. Both tools estimate the absolute 10-year risk of hip fracture and major osteoporotic fractures (spine, wrist, or shoulder) expressed as a percentage.

FRAX® can be used for people aged 40 to 90 years, with or without bone mineral density (BMD) values, and provides a graphical risk categorisation (low, intermediate, high) based on National Osteoporosis Guideline Group (NOGG) guidance. QFracture® is validated for ages 30 to 84 years and includes more clinical variables but does not incorporate BMD.

A 10-year fracture risk of 10% or greater is considered a threshold to arrange a dual-energy X-ray absorptiometry (DXA) scan for further assessment. Clinical judgement and local pathways should also be considered.

FRAX® may underestimate risk in certain situations such as corticosteroid use, multiple fragility fractures, high alcohol intake, and in people over 80 years old, so clinical context is important.

Either FRAX® or QFracture® is recommended by NICE, SIGN, and NOGG guidelines for fracture risk assessment in postmenopausal women, with DXA scanning advised when risk is near intervention thresholds or in the presence of risk factors.