Beyond Fracture Probability: Communicating the Full Consequences of Fracture and Contextualization

Fracture risk calculators such as FRAX, the Garvan Fracture Risk Calculator, and QFracture are now embedded in clinical guidelines, yet they communicate only a single numerical probability. This review examines whether current tools adequately meet patients' informational needs and identifies critical gaps in fracture risk communication.

Most patients want fracture risk information, but only approximately half actually receive it. Research consistently shows that patients globally prefer visual over numerical formats, yet existing tools do not communicate the consequences of fracture, including mortality, subsequent fracture risk, and loss of independence, nor do they contextualise risk within available treatment options. Three critical gaps are identified: the consequence gap (what fracture means for survival and function), the controllability gap (how treatment modifies risk), and the format gap (how risk is presented and understood). Moving fracture risk communication beyond a single number requires integrating consequence, context, and format. The digital platform BONEcheck addresses these gaps by incorporating mortality risk, refracture risk, skeletal age, treatment contextualisation, and multi-format presentation including icon arrays. Future research, clinical practice, and guideline development should prioritise a more complete, actionable, and patient-centred approach to fracture risk communication.