[Usefulness of FRAX and future issues in women's health]

With the recent development of diverse therapeutic modalities for osteoporosis, there is an increasingly recognized need to develop cost-effective strategies to determine which patients will benefit most from pharmacologic treatment. The World Health Organization (WHO) has developed a 10-year osteoporotic fracture risk assessment tool (FRAX) based on clinical risk factors combined with bone mineral density measured at the femoral neck. In postmenopausal women, age and prior history of fragility fracture were found to be major contributing factors to osteoporotic fracture risk as assessed by FRAX. In the US, the National Osteoporosis Foundation (NOF) guidelines recommend treatment in patients with osteopenia when the 10-year probability of major osteoporotic fracture is = 20% or the hip fracture is = 3%. On the other hand, in the UK, the National Osteoporosis Guideline Group (NOGG) has developed a case finding approach for individuals whose 10-year probability of major osteoporotic fracture exceeds age-specific thresholds. The FRAX algorithms may be worth incorporating in a cost-effectiveness model for socioeconomic analyses to determine the pharmacological intervention threshold for osteoporosis treatment. FRAX represents a significant advance for practitioners in women's health as an easy-to-use calculator of osteoporotic fracture probability. However, it should be noted that FRAX is intended as a guideline for clinical decision making only and does not force the decision to treat on physicians.