What do the MOF and hip fracture percentages actually mean?

MOF is your estimated probability of a major osteoporotic fracture — hip, spine, forearm or shoulder — in the next 10 years. The hip figure is the probability of a hip fracture specifically over the same period. A MOF of 12% means that out of 100 people with your risk profile, about 12 would be expected to have such a fracture within 10 years.

Why does this calculator use Indian thresholds instead of the Western ones?

Indians fracture 10 to 20 years earlier than Western populations, so applying Western intervention cut-offs under-treats Indian patients. This tool defaults to the ISBMR India thresholds — treatment considered at MOF ≥14% or hip ≥3.5% — and lets you switch to the Western NOF thresholds of MOF ≥20% or hip ≥3% for comparison.

Can I use this calculator without a DXA scan or T-score?

Yes. FRAX was designed to work without bone density, and the T-score field is optional. Entering a femoral neck T-score if you have one makes the estimate substantially more accurate, which is why a DXA scan is usually the next clinical step if your risk comes back elevated.

What is the OSTA score?

OSTA — the Osteoporosis Self-Assessment Tool for Asians — is a simple pre-screen derived from just age and body weight, validated in Asian populations. It does not replace FRAX. It is shown alongside your fracture probabilities as a quick cross-check on whether bone density testing is worth pursuing.

How much calcium and vitamin D do I actually need?

The tool generates your targets from the ICMR-NIN 2024 Dietary Guidelines for Indians, stratified by age and sex — for example 1200 mg of calcium and 800 IU of vitamin D per day for adults aged 60 and over, for both men and women. If your vitamin D is deficient, the Indian expert consensus correction regimen is shown separately.

Does a high fracture risk score mean I definitely need medication?

No. Crossing an intervention threshold means pharmacotherapy should be discussed, not that it is automatic. The decision belongs to your doctor and depends on your DXA result, your fracture history, other conditions and medicines you take, and your own preferences. This tool is a screening estimate, not a prescription.

Osteoporosis & Fracture Risk Calculator

Quick eligibility check

This screener uses the clinical risk factors from the FRAX® framework, interpreted with Indian evidence. FRAX® itself is validated for ages 40–90, so this tool is built for that range. Please confirm which best describes you.

What is the FRAX tool?

FRAX® (Fracture Risk Assessment Tool) was developed at the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield. It was not developed or endorsed by the WHO itself, and calling it a “WHO tool” is a common error. It estimates a 10-year absolute probability of a major bone fracture — hip, spine, wrist or shoulder. This screener is not FRAX®: it weighs the same risk factors with its own approximation, so treat its figures as an estimated range, not an official FRAX® probability. It accounts for 8 independent clinical risk factors and produces two outputs: Major Osteoporotic Fracture (MOF) probability and Hip Fracture (HF) probability. This tool uses the India-specific calibration with ISBMR intervention thresholds.

About you

Your age, sex, and body measurements are the most powerful drivers of fracture risk — more important than any single lifestyle factor.

How old are you?

Why age matters so much: Fracture risk roughly doubles every 10 years after 50. This is because bone-forming cells (osteoblasts) steadily decline with age, while bone-removing cells (osteoclasts) stay active. Falls also become more likely with age due to muscle loss and balance changes.

years

FRAX is validated for ages 40–90

What is your biological sex?

Why sex matters: Women have smaller bones than men at baseline. After menopause, the sudden loss of estrogen triggers a rapid acceleration of bone loss — up to 3–5% per year in the first 5 years — that far outpaces normal male age-related bone loss. Women have significantly higher lifetime fracture risk than men of the same age.

Your measurements

Why BMI matters: A BMI below 19 kg/m² is one of the strongest independent predictors of fracture — it indicates frailty, low muscle mass, and inadequate nutritional intake. Very low body weight also deprives bones of the mechanical loading they need to stay strong.

Height (cm)

Weight (kg)

Do you know your femoral neck T-score? optional — improves accuracy

Enter the femoral neck T-score only. Your DXA report lists several sites — use the femoral neck figure (sometimes printed as “Neck” under the hip section). Do not enter the lumbar spine or total hip T-score here; FRAX® is built on femoral neck BMD and the other sites will skew the estimate. Enter the number exactly as printed. Leave blank if you haven't had a scan.

T-score

Normal: ≥ -1.0 · Osteopenia: -1.0 to -2.5 · Osteoporosis: ≤ -2.5

Do not adjust your T-score for ethnicity. The International Society for Clinical Densitometry recommends a single uniform young-adult reference for T-scores in all ethnic groups (NHANES III for femoral neck and total hip); population-specific databases are used for Z-scores, not T-scores. Indian normative data such as CUBES (Aggarwal A, Pal R, Bhadada SK et al., Arch Osteoporos 2021;16:17) matter for estimating population prevalence, but they are not a reason to treat your own T-score as less severe than your report states. Enter it as printed and let your doctor interpret it.

Fracture & family history

A prior fracture is the strongest single predictor that your bones will break again. Family history tells us about inherited skeletal fragility you may have been born with.

Have you ever had a fragility fracture as an adult?

This is the single most important risk factor. A prior fragility fracture means your bones have already structurally failed once. It dramatically increases your risk of another fracture — especially in the next 24 months. If you've broken more than one bone, this is even more critical.

Has either of your biological parents had a hip fracture?

Why parents matter: Peak bone mass, bone geometry, and microstructural strength are highly heritable. A parent who broke their hip is a red flag for inherited skeletal fragility — this is one of the highest-weighted variables in the FRAX algorithm (second only to glucocorticoid use among the dichotomous risk factors).

Do you have a confirmed diagnosis of Rheumatoid Arthritis (RA)?

Important: Only select "Yes" if you have a confirmed RA diagnosis from a rheumatologist. Do NOT select this for osteoarthritis — osteoarthritis does not increase fracture risk and may actually give falsely high DXA readings. RA is the only specific disease to have its own dedicated field in the FRAX tool.

Medical conditions & hormones

Certain medications, hormonal changes, and underlying conditions can cause severe bone loss completely independent of age — sometimes even in young adults.

Have you taken oral steroids (glucocorticoids) for more than 3 months?

Why steroids are so damaging to bone: Oral steroid tablets (prednisolone, dexamethasone) — taken by mouth for conditions like asthma, arthritis, or IBD — are the single most common medication cause of osteoporosis. They directly kill bone-forming cells and cause bone deterioration that begins within weeks of starting treatment. This threshold is 5mg of prednisolone per day (or equivalent) for 3+ cumulative months. Inhalers, skin creams, and eye drops do NOT count.

At what age did your periods stop naturally? What is your menopause status?

🔵

Pre-menopausal

Still having regular periods. Ovaries producing estrogen normally. Estrogen protects bones by limiting osteoclast (bone-resorbing cell) activity. BMI modifiers for bone loss are minimal at this stage.

🟡

Perimenopausal transition

Periods becoming irregular but not stopped for 12+ months. Estrogen begins fluctuating dramatically. Bone loss accelerates. Typical Indian age: 40–48 years. Symptoms: irregular bleeds, hot flushes, sleep disruption, mood changes.

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Post-menopausal bone loss accelerates

No periods for 12+ consecutive months. Ovarian estrogen production ceases. Bone loss: 3–5% per year in the first 5 years. Indian average age: 46.2 years (vs 51.4 years globally). After menopause, fat tissue becomes the main estrogen source — making weight management critically important.

Key FRAX rule for this calculator: If you experienced menopause before age 45 (premature or early menopause), this automatically activates the "Secondary Osteoporosis" variable in the FRAX calculation — because the extended estrogen deficiency is treated as a major independent driver of accelerated bone loss, not just age-related loss.

Do you have any of these medical conditions? select all that apply

These conditions cause bone loss through mechanisms entirely independent of normal aging — often affecting people in their 20s, 30s, and 40s. If any apply, they activate the "Secondary Osteoporosis" variable in the FRAX calculation. For women with early/premature menopause: this is automatically applied — you don't need to select it again.

Lifestyle factors

Smoking and alcohol each directly damage bone cells and impair the hormonal systems that protect your skeleton. These are modifiable — changing them today reduces your future fracture risk.

Do you currently smoke tobacco?

How smoking damages bone: Nicotine is directly toxic to osteoblasts (bone-forming cells). Smoking also accelerates estrogen clearance from the body — women who smoke tend to enter menopause 1–2 years earlier — and reduces intestinal calcium absorption. FRAX only counts current, active smoking. Past smoking, even long-term, is not included in the standard algorithm.

How much alcohol do you drink?

How alcohol damages bone: Chronic heavy alcohol directly inhibits osteoblast (bone-forming cell) activity, causes severe calcium and vitamin D deficiency through gastrointestinal and liver damage, and dramatically increases fall risk due to balance and neurological effects. The FRAX threshold is 3 or more units per day — equivalent to roughly 3 large beers or 3 measures of spirits daily.

Which intervention threshold should we apply? select your region

Treatment thresholds determine when the benefit of taking long-term bone medication outweighs its risks. The ISBMR has established lower thresholds specifically for India (14% MOF / 3.5% hip) because the Indian FRAX module is known to underestimate true risk (it was calibrated using Singaporean data). These lower thresholds prevent under-treatment of high-risk Indian patients.

This calculator generates estimated fracture probabilities from the FRAX® clinical risk factors using its own approximation — it does not run the official FRAX® algorithm. It is an educational and screening tool — not a substitute for a clinical consultation, DXA scan, or physician-led fracture risk assessment. All results require interpretation by a qualified doctor or specialist.

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Is your bone health
quietly at risk?

Quick eligibility check

About you

Fracture & family history

Medical conditions & hormones

Lifestyle factors

Your Results — In Plain English

Your Risk Factor Breakdown

Treatment & Screening Recommendation

Your Personalised Bone Nutrition Targets

Lifestyle Actions to Reduce Fracture Risk

Methodology, Science & Glossary

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Quick eligibility check

About you

Fracture & family history

Medical conditions & hormones

Lifestyle factors

Your Results — In Plain English

Your Risk Factor Breakdown

Treatment & Screening Recommendation

Your Personalised Bone Nutrition Targets

Lifestyle Actions to Reduce Fracture Risk

Methodology, Science & Glossary

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