Table 2 Limitations of the Fracture Risk Assessment Tool for case finding

- Factors not included in FRAX:

   • The 'dose effect' of some risk factors

• Glucocorticoid use (dose and duration)

• Characteristics of previous fractures (location, number, and severity)

   • Fall risks

   • Vitamin D deficiency

   • Fluctuation over time of subsequent fracture

   • Markers of bone formation and bone resorption

   • How to identify patients with a vertebral fracture

   • Which laboratory tests are indicated (and in whom) to exclude secondary osteoporosis

- FRAX is applicable only in untreated patients.

- Inclusion of BMD results is limited to results of BMD in the femoral neck. However, total hip BMD can be used interchangeably with femoral neck BMD in women, but not in men.

- FRAX does not indicate which intervention is indicated at which level of 10-year fracture risk of hip or major fractures (for either nonpharmacological or drug treatment).