DietXP Osteoporosis Risk Calculator

🦴 WHO FRAX framework with Indian ISBMR calibration

🇮🇳 India-specific intervention thresholds (MOF ≥14% / HF ≥3.5%)

🥛 ICMR-NIN 2024 calcium & vitamin D prescriptions

⚡ OSTA score + imminent fracture risk flagging

Quick eligibility check

This tool uses the WHO FRAX framework adapted with Indian ISBMR thresholds. It is designed for adults aged 40–90. Please confirm which best describes you.

What is the FRAX tool?

FRAX (Fracture Risk Assessment Tool) was developed by the WHO and calculates your 10-year absolute probability of suffering a major bone fracture — specifically a hip, spine, wrist, or shoulder fracture. Unlike a relative risk score, this is the actual percentage chance of fracture over the next 10 years. 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 DXA bone density T-score? optional — improves accuracy

If you have had a DXA bone scan, your report will show a T-score — usually at the femoral neck (hip). Entering it here significantly improves the precision of your fracture risk calculation. Leave blank if you haven't had a scan yet.

T-score

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

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.

🟠

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 based on the WHO FRAX framework with clinical approximations. 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.

BONE HEALTH NUTRITION

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Evidence-based dietary guidance: calcium & vitamin D optimisation, protein targets, anti-inflammatory nutrition, and ICMR-NIN 2024 / ESPEN personalised action plans.

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WHAT MAKES THIS DIFFERENT

🇮🇳

Indian ISBMR intervention thresholdsMOF ≥14% / HF ≥3.5% — preventing under-treatment

🦴

FRAX + OSTA dual scoringWHO framework + Asian self-assessment tool

🔴

Imminent fracture risk flaggingPrior fracture <24 months → urgent specialist referral

🥛

ICMR-NIN 2024 nutrition targetsAge/sex-stratified calcium & vitamin D prescriptions

⚡

Premature menopause auto-logicMenopause <45y auto-activates Secondary Osteoporosis

IMPORTANT LIMITATIONS

FRAX India calibrationThe India FRAX module was calibrated from Singaporean expatriate data — it may underestimate native Indian risk, particularly in rural or lower-socioeconomic populations.

Approximation engineThis tool uses a validated clinical approximation of FRAX. For precise clinical scoring, use the official fraxplus.org tool with your doctor.

DXA recommendedFRAX with femoral neck BMD (T-score) is significantly more accurate. If you haven't had a DXA scan, this is the next clinical priority.

T2DM underestimationFRAX may underestimate risk in Type 2 diabetics — degraded bone microarchitecture is not captured by DXA. Clinical upward adjustment may be warranted.

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⚕️ Clinical Disclaimer: This tool generates estimated 10-year fracture probabilities using the WHO FRAX framework calibrated with Indian ISBMR thresholds and ICMR-NIN 2024 nutritional guidelines. It is a validated clinical screening instrument — not a diagnostic tool. All results require physician interpretation. Screening and treatment decisions must be individualised by your doctor, rheumatologist, or endocrinologist. This tool is intended for adults aged 40–90 with no active bone malignancy.

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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 Nutrition Prescription

Lifestyle Actions to Reduce Fracture Risk

Methodology, Science & Glossary

Protect Your Bones

Search

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 Nutrition Prescription

Lifestyle Actions to Reduce Fracture Risk

Methodology, Science & Glossary

Protect Your Bones

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