When is a fracture risk assessment (like FRAX) done?
In the UK, a fracture risk assessment, most commonly using the FRAX (Fracture Risk Assessment Tool), is the standard first step in diagnosing osteoporosis and managing bone health. It is not a test performed for everyone; instead, it is used by GPs and specialists to determine the mathematical probability of a patient breaking a major bone over the next ten years. According to the latest clinical pathways, this assessment is the gatekeeper for further testing, such as a DEXA scan. It is typically performed during routine health reviews, following an injury, or when a patient’s medical history suggests their bones may be thinning.
What We’ll Discuss in This Article
- The primary age thresholds for routine FRAX assessments
- When younger adults (under 50) require a risk calculation
- Why a fragility fracture triggers an immediate assessment
- The role of FRAX in managing long-term medication risks
- How the 2026 NICE updates influence when assessments occur
- What happens after your risk score is calculated
Assessments are recommended for all women over 65 and men over 75.
Under current NICE guidance, age is the most significant factor in determining when a FRAX assessment should be carried out. Because bone density naturally declines with age, the probability of a fracture increases even in those who feel healthy.
UK clinicians are encouraged to perform a FRAX assessment for:
- All women aged 65 and over.
- All men aged 75 and over.
In many GP surgeries, this assessment happens during an annual review or a routine check-up. The tool allows the doctor to see if the patient’s age-related bone loss has reached a point where preventative treatment or a DEXA scan is necessary to maintain their independence.
Younger adults are assessed if they have specific clinical risk factors.
For individuals under the age of 65 (women) or 75 (men), a FRAX assessment is only done if they have a “red flag” in their medical history. These factors suggest that their bones may be thinner than expected for their age.
A GP will typically perform a FRAX calculation if a younger adult:
- Has sustained a fragility fracture: A break from a minor trip or fall.
- Has a parental history of hip fracture: A strong indicator of inherited fragility.
- Has a very low Body Mass Index (BMI): Specifically a BMI of 19 or less.
- Has a history of heavy smoking or alcohol use: (More than 3 units a day).
- Has an underlying condition: Such as rheumatoid arthritis, Type 1 diabetes, or Coeliac disease.
Long-term steroid use is a major trigger for an early assessment.
If you are prescribed oral corticosteroid tablets (such as prednisolone) for three months or more, a fracture risk assessment is mandatory. Steroids are known to cause rapid bone loss by suppressing bone-building cells.
According to NHS protocols, the risk of fracture increases within weeks of starting steroid therapy. Therefore, the FRAX assessment is often done at the start of the medication course to establish a baseline. This allows the doctor to decide if you need bone-protective medication (like bisphosphonates) alongside your primary treatment to prevent steroid-induced osteoporosis.
2026 NICE Update: Integrated assessments for high-risk life stages.
As of 2026, updated NICE standards place a greater emphasis on using FRAX during specific life transitions. For example, women who experience an early menopause (before age 45) should now receive a FRAX assessment as part of their initial menopause consultation.
Furthermore, the 2026 guidelines suggest that any patient undergoing an NHS Health Check (for those aged 40–74) should have their fracture risk considered if they have even one minor risk factor. By integrating the assessment into these existing appointments, the NHS aims to identify bone fragility earlier, potentially preventing thousands of hip and spinal fractures each year.
FRAX is used to decide if you need a DEXA scan.
The main reason a FRAX assessment is done is to determine if you need a bone density scan. The tool categorises patients into three groups based on their results:
- Green (Low Risk): No further action is needed, other than lifestyle advice on diet and exercise.
- Amber (Intermediate Risk): A DEXA scan is recommended to provide more data for the risk calculation.
- Red (High Risk): Treatment is usually recommended immediately, often without the need for a scan if the risk is high enough.
This step-by-step approach ensures that scans are targeted at those who truly need them, while providing a clear management plan for everyone else.
Conclusion
A fracture risk assessment like FRAX is performed when a person’s age or medical history indicates a higher likelihood of bone fragility. For women over 65 and men over 75, it is a routine part of healthy ageing. For younger adults, it is a targeted response to previous fractures, specific health conditions, or high-risk medications. With the 2026 drive for earlier identification, these assessments are becoming a standard part of preventative care in the UK. If you have any of the risk factors mentioned above, discuss a FRAX review with your GP. If you experience severe, sudden, or worsening symptoms, call 999 immediately.
What is a fragility fracture?
It is a broken bone that occurs from a low-impact event, such as a fall from a standing position. This is the biggest single reason for a FRAX assessment.
Does a low FRAX score mean I definitely won’t break a bone?
It means your probability is low over the next ten years, but it is not a guarantee. Maintaining a healthy lifestyle is still essential.
Will my FRAX score change if I quit smoking?
Yes, quitting smoking reduces your risk profile, and this will be reflected in a lower FRAX score over time as your body recovers.
Why is my FRAX score high if I have never broken a bone?
Age, family history, and low body weight are very powerful factors in the FRAX model and can lead to a high score even without a previous injury.
How often should a FRAX assessment be repeated?
If your risk is low, it is usually repeated every 5 years. If you are on treatment or have new risk factors, your GP may repeat it every 2 to 3 years.
Does FRAX take my diet into account?
No, FRAX focuses on medical and lifestyle history. However, your GP will discuss your calcium and vitamin D intake as part of the overall review.
Authority Snapshot (E-E-A-T Block)
This article explores the clinical timing and necessity of fracture risk assessments within the UK. It has been written and reviewed by Dr. Stefan Petrov, a UK-trained physician, to ensure the information is accurate and reflects the latest 2026 NHS and NICE standards. The content is designed to help patients understand when they should expect or request a formal review of their bone health.
