FRACTURE Index Calculator
Calculate your 5-year hip fracture risk using the validated FRACTURE Index assessment tool. This evidence-based calculator helps evaluate bone health and fracture probability for postmenopausal women.
The FRACTURE Index calculator is a scientifically validated tool developed by Black et al. in 2001 to assess your 5-year probability of experiencing a hip fracture. This fracture risk calculatoruses simple clinical risk factors to provide personalized hip fracture risk assessment, making it an essential osteoporosis calculator for healthcare providers and patients, particularly postmenopausal women.
Our FRACTURE Index tool implements the exact methodology from the originalBlack et al. study published in Osteoporosis International, helping you understand how various risk factors contribute to hip fracture probability. The bone density calculatorcomponent considers T-scores from DXA scans when available, providing more accurate risk stratification forhip fracture risk assessment.
The FRACTURE Index is a simple point-based algorithm that calculates the 5-year probability of hip fracture in postmenopausal women. This fracture probability calculator was developed using data from the Study of Osteoporotic Fractures (SOF), a large prospective cohort study, and has been validated in clinical practice.
The FRACTURE Index calculator considers six key clinical risk factors: age, history of fracture after age 50, mother's history of hip fracture after age 50, weight, current smoking status, and inability to rise from a chair without using arms. When available, bone mineral density (BMD) T-scores from the total hip can be included to enhance accuracy. According to theNIH Osteoporosis and Related Bone Diseases National Resource Center, simple risk assessment tools like the FRACTURE Index are valuable for identifying high-risk individuals.
| Risk Factor | Points Assigned | Clinical Significance |
|---|---|---|
| Age 65-69 | 1 point | Age is the strongest predictor |
| Age 70-74 | 2 points | Risk increases with each decade |
| Age 75-79 | 3 points | Exponential increase in risk |
| Age 80-84 | 4 points | Very high risk group |
| Age ≥85 | 5 points | Highest risk group |
| Previous fracture after 50 | 1 point | Strong predictor of future fractures |
| Mother's hip fracture | 1 point | Genetic and lifestyle factors |
| Weight ≤125 lbs | 1 point | Low body weight increases risk |
| Current smoking | 1 point | Affects bone metabolism |
| Need arms to stand | 2 points | Indicates frailty and fall risk |
Understanding your FRACTURE Index score is crucial for making informed decisions about bone health. The results provide your 5-year risk of hip fracture based on your total point score. The interpretation differs depending on whether bone mineral density (BMD) data is available, with BMD providing more precise risk stratification.
The CDC emphasizesthat fracture risk assessment tools help identify individuals who may benefit from further evaluation and treatment. Higher FRACTURE Index scores indicate increased need for bone health optimization and potential medical intervention.
Without BMD Results:
- 0 points: <0.6% risk (Very Low)
- 1 point: 0.6% risk (Low)
- 2 points: 1.4% risk (Low-Moderate)
- 3 points: 2.1% risk (Moderate)
- 4 points: 3.2% risk (Moderate-High)
- ≥5 points: 8.2% risk (High)
With BMD Results:
- 0 points: <0.4% risk (Very Low)
- 1-2 points: 0.4% risk (Low)
- 3-4 points: 0.9% risk (Low-Moderate)
- 5 points: 1.9% risk (Moderate)
- 6-7 points: 3.9% risk (Moderate-High)
- ≥8 points: 8.7% risk (High)
While the FRACTURE Index can be calculated without bone mineral density (BMD) data, including T-scores from a DXA scan provides additional points that improve risk stratification. The BMD calculator component uses total hip T-scores, which represent how many standard deviations your bone density is from that of a healthy 30-year-old adult.
According to the FDA guidance on bone densitometry, DXA scans are the gold standard for measuring bone density. When T-scores are available, they should be entered into the FRACTURE Index calculator for the most accurate risk assessment. The point system for BMD is:
| Total Hip T-Score Range | Points Added | Clinical Interpretation |
|---|---|---|
| ≥ -1.0 | 0 points | Normal bone density |
| -1.0 to -2.0 | 2 points | Mild bone loss (osteopenia) |
| -2.0 to -2.5 | 3 points | Moderate bone loss |
| < -2.5 | 4 points | Osteoporosis |
The FRACTURE Index is one of several validated fracture risk assessment tools available to healthcare providers. While the WHO FRAX tool (developed later) provides 10-year risk estimates for multiple fracture types, the FRACTURE Index specifically focuses on 5-year hip fracture risk using a simpler, more accessible approach.
Research published in theSurgeon General's Report on Bone Health and Osteoporosisemphasizes that multiple validated tools can be used for fracture risk assessment. The FRACTURE Index's simplicity makes it particularly useful in primary care settings and for patient self-assessment.
Key Advantages of the FRACTURE Index:
- Simple, easy-to-use point system
- Specifically validated for hip fracture prediction
- Can be used with or without BMD data
- Based on large prospective cohort study
- Suitable for postmenopausal women
- Provides 5-year risk estimates
The FRACTURE Index was developed using data from the Study of Osteoporotic Fractures (SOF), a large prospective cohort study that followed over 9,000 postmenopausal women for fracture outcomes. The original validation study, published by Black et al. in Osteoporosis International in 2001, demonstrated good predictive accuracy for hip fractures over a 5-year follow-up period.
The tool's development followed rigorous epidemiological methods, with risk factors selected based on their independent association with hip fracture risk in multivariate analyses. The simple point system was designed to be clinically practical while maintaining good discriminative ability for identifying high-risk individuals.
Key Study Characteristics:
- Study population: 9,516 postmenopausal women aged 65+
- Follow-up period: 5 years for fracture outcomes
- Primary outcome: Hip fracture incidence
- Validation: Internal validation within SOF cohort
- Publication: Osteoporosis International 2001;12(7):519-528
Last updated: June 1, 2025
This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for personalized fracture risk assessment and treatment recommendations.
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Reviewed by Dr. Joshua Cassinat, MD, Board-Certified Physician
Last medically reviewed: June 1, 2025