FRAX is the 10-year fracture-risk score that most physicians use to drive osteoporosis medication decisions. It combines your femoral neck DEXA T-score with clinical factors like age, prior fracture, and family history. Because FRAX is driven by the femoral neck reading, any real DEXA gain at that site lowers your FRAX number. Austin member Ruth watched her FRAX score fall from 57% to 24% during her time at OsteoStrong. Reducing FRAX without medication is possible for appropriately screened patients and always a conversation with your physician.
The number that drives the medication conversation
If your physician has recommended starting an osteoporosis medication, there is a strong chance the recommendation was driven by your FRAX score - a 10-year fracture-risk estimate produced by a WHO-validated calculator. FRAX is the single most common input to that decision in U.S. primary care and endocrinology.
Most women who hear "let's talk about starting a medication" have no idea what FRAX is or how it was calculated. Understanding it is useful because:
- It shows you exactly which clinical factors are driving your risk.
- It tells you which ones you can move and which ones you cannot.
- It lets you have a real conversation with your doctor about whether and how much you want to rely on medication.
How FRAX is calculated
FRAX combines your femoral neck T-score with a small set of clinical inputs:
- Age, sex, height, weight (BMI)
- Prior fragility fracture, yes or no
- Parental hip fracture, yes or no
- Current smoking, yes or no
- Long-term glucocorticoid use (prednisone and similar), yes or no
- Rheumatoid arthritis, yes or no
- Other secondary osteoporosis causes, yes or no
- Current alcohol use (3+ units per day), yes or no
It produces two numbers:
- 10-year probability of a major osteoporotic fracture (spine, hip, wrist, or upper arm)
- 10-year probability of hip fracture
U.S. clinical thresholds that commonly trigger medication consideration:
- Major osteoporotic fracture: 20% or higher over 10 years.
- Hip fracture: 3% or higher over 10 years.
These thresholds come from National Osteoporosis Foundation guidance. Your individual recommendation depends on your physician's read of your whole picture.
What you can move, and what you can't
Of the FRAX inputs, some are fixed and some are moveable.
Fixed. Age (it only goes up). Parental hip fracture. Prior fracture history. Sex.
Moveable. Femoral neck T-score. Smoking. Heavy alcohol use. Long-term steroid use in some cases.
The femoral neck T-score is the input most of our members focus on because it is the one osteogenic loading targets directly. As femoral neck density improves, FRAX drops.
Ruth's story: 57 to 24
Ruth H. - FRAX 57% to 24%
10-year fracture risk dropped from 57% to 24%
"My risk of fracture dropped from 57% to 24%."
Ruth's intake FRAX of 57% was in the range where medication was a strong consideration. She chose to add osteogenic loading alongside her physician's plan. Her follow-up FRAX at 24% is dramatically lower - the result of improved femoral neck density moving the whole calculator.
Ruth is one of our clearest examples of what a sustained DEXA improvement does to the downstream risk number. FRAX is not a feelings-based score - it is math that you do not move by thinking good thoughts. Ruth moved it by changing the measurable inputs.
Two other members whose FRAX almost certainly moved
FRAX scores are not universally calculated or reported to us, but the clinical trajectory of two of our members makes it clear their FRAX numbers moved significantly.
Dora - spine +20%, hip +16%
DEXA gains likely dropped FRAX by half or more
Dora exited the osteoporotic range at both the spine and hip. A change of that magnitude at the femoral neck component of the hip reading typically cuts a patient's FRAX score by half or more. Her physician, not we, would be the one to report her updated FRAX.
Angie - hip +9%, out of osteoporosis
Hip out of osteoporotic range
Angie's 9% hip gain brought her femoral neck T-score above the -2.5 threshold. That kind of site-specific improvement directly lowers the FRAX input for hip fracture risk.
What FRAX does not measure
FRAX is the best tool we have, but it is not a complete picture of fracture risk. Things it does not measure:
- Balance and fall frequency. If you never fall, even weak bones often don't fracture. FRAX assumes a typical-for-age fall exposure. Members who have trained reflexive balance may have effective fracture risk well below their FRAX number.
- Muscle strength. A strong hip muscle can absorb a fall impact and prevent a fracture even when bone density is low. FRAX doesn't know how much hip strength you have.
- Grip strength. The mortality predictor FRAX ignores.
- Vitamin D status, nutritional factors, diet quality.
- Medication compliance. FRAX assumes no current osteoporosis medication; if you are on one, your real-world risk is likely lower than FRAX suggests.
This is not a critique of FRAX. It is a reminder that FRAX is a simplification and your real risk is the integrated picture of everything FRAX does measure plus everything it does not.
What to do with your FRAX
Three practical actions:
- Ask your physician for your FRAX number if they haven't shared it. You are entitled to it.
- Write it down and ask what the number would be if your femoral neck T-score improved by 0.5 or 1.0. This tells you the upside of DEXA work.
- Ask which of your fixed inputs dominate the score. If the biggest driver is age and parental fracture history, you cannot move those - but you can move the T-score that FRAX weights alongside them.
What to do next
If you have a FRAX score you want to change, the practical next step is a free 15-minute Bone Health Call. We will walk through your DEXA, your FRAX, and what a realistic 18 to 24 month target for the femoral neck T-score looks like.
Related reading:
- Femoral Neck Density: The Fracture Site That Matters Most
- Hip Bone Density After 50
- The Day After Your Osteoporosis Diagnosis
- Reversing Osteoporosis: What Women Over 50 Actually Accomplish
Your simple plan from here
- Book your free Bone Health Call. 15 minutes, phone or Zoom, no pressure.
- Come in for a guided first session. A coach walks you through all four devices.
- Track your strength week after week. 15 minutes, once a week. The numbers rise.
Frequently asked questions
Is OsteoStrong safe if I already have osteoporosis?
We hear this one a lot, and the honest answer is that a new osteoporosis diagnosis is exactly why most of our members walked in. You stay in complete control the entire session - the devices don't move, you push against a fixed resistance, and a certified coach is beside you cueing every breath. More than 100 Austin-area physicians refer patients here, including women with severe DEXA results. The safest next step is simply to talk to us. Book your free 15-minute Bone Health Call and we'll walk through your DEXA together.
Can I really build bone density at my age?
Yes, and the question tells us you already suspected the answer. Bone is living tissue that responds to a specific mechanical signal at any age. Our members in their 70s, 80s, and 90s routinely see measurable DEXA improvements, and 8 out of 10 who follow the weekly protocol see bone density gains on follow-up scans. If your doctor has told you 'it's just age,' that's half the story. The best way to find out what's possible for your body is a free Bone Health Call.
What actually happens during a session?
Most women show up nervous and leave surprised at how simple it was. You arrive in street clothes, meet your coach, and walk through four supported devices that produce the exact force your bones need to rebuild. Total time: about 15 minutes. No cardio. No sweat. No locker room. You never change clothes. Most members come on their lunch break.
Do I really only need to come once a week?
Yes, and we know that sounds too easy to be real. When your body receives the osteogenic-loading signal, it keeps rebuilding for 7 to 10 days afterward. More frequent sessions don't produce more results - consistency, once a week, is what creates lasting change. This is the whole reason this method works for women over 50 who do not want a gym routine.
How is this different from going to the gym?
A regular gym trains muscles, which is wonderful but doesn't move the needle on bone. Research suggests bone only rebuilds when it receives roughly 4.2 times your body weight in force - a level you cannot safely produce with free weights, yoga, or Pilates. OsteoStrong's devices let your body generate that precise force safely, in four short efforts, in 15 minutes. Same room. Same coach. Every week.
What does it cost?
We know price is on your mind, and we respect that. We don't post pricing online because memberships vary by location and household (individual, couple, family). Your free 15-minute call covers pricing, location options, and any questions about your specific situation - no sales pressure, no long form to fill out in between.
Will my doctor approve?
Most do. Over 100 Austin-area physicians already refer patients to us, and we're glad to send educational materials to yours. We always recommend sharing your DEXA results with us so we can track your progress alongside your physician's plan. If it helps your decision, ask your doctor what she thinks of osteogenic loading - and then book your free call.
What if I've never exercised?
You are exactly who this was built for. Most of our members aren't athletes. You do not need to be fit, flexible, or experienced, and you will not be asked to do anything your body cannot do. A certified coach is beside you every session, adjusting everything to you. If you've been avoiding gyms for 30 years, this is the place you don't have to.
Do I have to sign a long contract?
No surprises here. We offer month-to-month and longer memberships, and the pros and cons of each are walked through on your free call. We'll never pressure you into a commitment that doesn't fit your situation.
How soon will I feel a difference?
Most members notice improvements in energy, balance, and posture within the first 4 to 6 weeks - long before any DEXA change. On DEXA, the typical pattern is a halt of bone loss in year one with measurable density gains showing up in year two. Bone remodels slowly. We plan the journey in years, not months, and your weekly force-output numbers give you something to watch in the meantime.
How does OsteoStrong help with osteoporosis?
Osteoporosis means your bones have lost enough mineral that a simple fall can become a fracture. OsteoStrong adds the one thing your body cannot get from medication alone: the mechanical signal that tells bone to rebuild. Four devices, 15 minutes a week, and a coach who has seen hundreds of women in your exact spot. The best first step is a free Bone Health Call where we look at your DEXA together.
Is OsteoStrong a replacement for my osteoporosis medication?
No - we're not here to replace your doctor or your prescriptions. We're here to give you a simple weekly routine that supports your bone health alongside your medical plan. Some members, after sustained DEXA gains, have worked with their physician to taper or discontinue medications. That decision is always between you and your doctor, never between you and us.
Is OsteoStrong right for postmenopausal women?
It's built for you. Postmenopausal women are our largest group of members, because menopause is when bone loss accelerates and estrogen protection drops. Osteogenic loading delivers the signal your body needs without the high-impact movement that menopausal joints often cannot tolerate. If that sounds like the season you're in, book your free call.
Does insurance cover OsteoStrong?
Usually not, and we'll give you the straight answer: OsteoStrong is a wellness service, not a medical treatment, so most U.S. insurance plans don't cover it. Some members use HSA or FSA funds. Your free Bone Health Call covers pricing and payment options for your specific situation.
How is OsteoStrong different from physical therapy or the gym?
Physical therapy is medical rehabilitation and usually ends when you've recovered. A gym provides general exercise but rarely reaches the force threshold associated with bone rebuilding. OsteoStrong is a single-purpose service focused on triggering the osteogenic-loading signal. One coach, four devices, 15 minutes, once a week, indefinitely. Many of our members keep their PT or their gym and simply add OsteoStrong for bone health.
What happens if I don't do anything about bone loss?
This is the question we wish more women asked, and we'll give you a gentle but honest answer. Bone loss is quiet. It compounds year after year until a simple trip becomes a fracture. One in two women over 50 will break a bone because of osteoporosis in her lifetime. Forty percent of hip-fracture patients lose the ability to live independently, and nearly one in four dies within a year. Those are the stakes. The good news: the next step is small, it's free, and it's a 15-minute phone call. Book your free Bone Health Call - we'll meet you where you are.
I'm scared. What should I do first?
Of course you are. Bone loss is a quiet thing that suddenly becomes very loud at a doctor's appointment, and no one sat with you and walked through what comes next. Start with the smallest, safest step: book a free 15-minute Bone Health Call. It's a phone or Zoom conversation with someone who has helped hundreds of women in your exact situation. We'll read your DEXA with you, answer your questions, and help you decide whether to come in. You don't commit to anything. You just get a real person to talk to.
What is FRAX?
FRAX is the Fracture Risk Assessment Tool, a validated calculator developed by the World Health Organization that estimates your 10-year probability of a major osteoporotic fracture (spine, hip, wrist, or upper arm) and hip fracture specifically. It combines your femoral neck T-score with clinical factors: age, body mass index, prior fracture, parental hip fracture history, current smoking, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis causes, and alcohol use.
What FRAX scores trigger medication?
In U.S. clinical practice, the commonly referenced thresholds are a 10-year major osteoporotic fracture risk of 20% or higher, or a 10-year hip fracture risk of 3% or higher. These thresholds come from National Osteoporosis Foundation guidelines. Your specific recommendation depends on your age, T-score, prior fracture history, and your physician's clinical judgment.
Can FRAX actually change?
Yes. Because FRAX incorporates your femoral neck T-score directly, any DEXA improvement at that site drops your FRAX score. Ruth, an Austin member, saw her FRAX drop from 57% to 24% over the course of her OsteoStrong membership. FRAX also drops when a fragility fracture stays in the rearview mirror without repeat - though the weight of history fades slowly.
Can osteogenic loading reduce FRAX without medication?
For appropriately screened patients, yes, and physicians are increasingly comfortable with non-drug interventions as part of the plan. Osteogenic loading at OsteoStrong targets exactly the DEXA sites FRAX incorporates - the femoral neck in particular. As density rises, FRAX falls. Medication can accelerate that trajectory and is appropriate for many women; it is always a decision between you and your physician.
How often should I recalculate FRAX?
Most physicians recalculate FRAX at each DEXA, typically every 18 to 24 months. You can also recalculate any time one of the clinical inputs changes - for example, if you stop smoking or a parent has a hip fracture. The WHO FRAX tool is publicly available online if you have your femoral neck T-score and want to estimate your own.
Is 20% FRAX 'high'?
Twenty percent is the U.S. threshold at which most physicians recommend considering medication. It is not a ceiling or a point of no return - many of our Austin and Georgetown members began with FRAX scores at or above this threshold and lowered them through sustained osteogenic loading. Ruth began at 57%, which is quite high, and ended at 24%, still within the therapeutic-consideration range but dramatically lower than where she started.