Spanish FRAX: Pathing the way through walking FRAX español: se hace camino al andar

Due to a greater life expectancy in developed countries such as Spain, the incidence of osteoporotic fracture is increasing,1 which has a direct effect on a higher health expense. In the case of hip fracture, which encompasses more severity, the incidence varies up to 7 times among different European countries, being Spain among the countries with lower incidence (711 cases per 100,000 women and year). Norway is considered to be of high incidence (1665 cases per 100,000 women and year) together with other countries from the north of Europe and America.2–4 These differences for hip fracture in both sexes are also observed among Spanish regions, being Catalonia the one of highest incidence and Galicia the lowest one (623 and 317 cases per 100,000 inhabitants and year, respectively).5 Opposite to a hip fracture incident, which occurs at an average age of 80 years, is prevention. In this context, age, sex and the most frequent risk factors such as early menopause, personal and family history of fracture and intake of corticosteroids are taken into account. The grater the number of present factors, the bigger the future risk of fracture. Sometimes bone densitometry is not available, or the patient’s risk is so high that the test is not necessary to start a treatment. Besides, we would have patients without risk factors whose probability of osteoporosis and fracture is low. But, certainly, there are many cases in which defining a high or low risk with a simple medical history is not easy. The FRAX tool was developed by WHO to assess the risk of fracture. It is based on models which combine clinical risk factors with or without bone mineral density (BMD) of the femoral neck. The models were built using information obtained from data of population cohorts from all 5 continents (FRAX version 3.8). The algorithms of FRAX calculate the probability of having hip fracture and main osteoporotic fracture (clinical vertebral fracture, forearm, hip or shoulder) in the next 10 years in men and women (http://www.shef.ac.uk/FRAX/index.aspx?lang=sp). The probability of fracture varies significantly in different regions; therefore, the thresholds of FRAX have to be measured for every country.6 The main application of FRAX is to identify those people who would be