Fracture risk assessment becomes more accurate with age-based thresholds

Fracture risk in Sweden has been overestimated, according to research from the University of Gothenburg. As health care tools are updated with new data, more people—including younger patients—may receive treatment. A widely used tool, FRAX, estimates the 10-year risk of osteoporotic fractures. The Swedish model is still based on data from the 1990s, despite substantial changes in both fracture incidence and population demographics since then.

In a new study published in the journal Osteoporosis International, researchers at the University of Gothenburg analyzed registry data covering the entire Swedish population aged 40 and older between 2005 and 2021.

A changing risk profile

“We see that the actual fracture risk in Sweden has declined. This means the model currently in use tends to overestimate risk. The differences in fracture risk between individuals born in the Nordic countries and those born elsewhere are large enough to justify two separate risk models,” says Mattias Lorentzon, Professor of Geriatric Medicine at the Sahlgrenska Academy, University of Gothenburg.

Current guidelines rely on a fixed treatment threshold of 20%, but the researchers propose replacing this with age-dependent thresholds.

“A fixed threshold risks missing younger patients with a high relative risk for their age, where continued bone loss means that treatment indication is often only a matter of time. With age-specific thresholds, we can identify these individuals earlier and prevent future fractures,” says Kristian Axelsson, first author and researcher at the Sahlgrenska Academy, University of Gothenburg.

Earlier intervention may prevent fractures

The proposed treatment thresholds range from around a 4.5% 10-year fracture risk at age 40 to just over 21% at age 70 and older. If adopted, more younger individuals may become eligible for assessment and treatment, despite a lower average risk across the population.

The updated models will be published on the official FRAX website on June 1, 2026, and an update to the Swedish Osteoporosis Society’s national care program is expected shortly.