The commonly used Fracture Risk Assessment Tool (FRAX), which includes self-identified race and ethnicity information, and the Osteoporosis Self-Assessment Tool (OST), which does not, had suboptimal performance in determining major osteoporotic fracture risk across racial/ethnic categories in younger postmenopausal women.
The commonly used U.S version of the Fracture Risk Assessment Tool (FRAX) should not be routinely used to select younger postmenopausal women for bone mineral density testing. FRAX includes self-identified race and ethnicity information, and the Osteoporosis Self-Assessment Tool (OST) does not, but both had suboptimal performance in determining major osteoporotic fracture risk across racial/ethnic categories in younger postmenopausal women. However, OST is excellent at identifying women with osteoporosis-level bone mineral density, which is the goal of these screenings, while FRAX is not. In addition, inclusion of racial/ethnic categories in clinical risk prediction tools is controversial and the subject of much debate.