PURPOSE: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk 
factors to estimate the probability of fracture over a 10-year period. Although 
falls increase fracture risk, they have not been incorporated into FRAX. It is 
currently unclear if FRAX captures falls risk and whether addition of falls 
would improve fracture prediction. We aimed to investigate the association of 
falls risk and Australian-specific FRAX.
METHODS: Clinical risk factors were documented for 735 men and 602 women (age 
40-90 yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the 
Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A 
falls risk score was determined at the time of BMD assessment and self-reported 
incident falls were documented from questionnaires returned one year later. 
Multivariable analyses were performed to determine: (i) cross-sectional 
association between FRAX scores and falls risk score (Elderly Falls Screening 
Test, EFST) and (ii) prospective relationship between FRAX and time to a fall.
RESULTS: There was an association between FRAX (hip with BMD) and EFST scores (β 
= 0.07, p < 0.001). After adjustment for sex and age, the relationship became 
non-significant (β = 0.00, p = 0.79). The risk of incident falls increased with 
increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). 
After adjustment for age and sex, the relationship became non-significant (1.01, 
95% CI 0.97, 1.05).
CONCLUSIONS: There is a weak positive correlation between FRAX and falls risk 
score, that is likely explained by the inclusion of age and sex in the FRAX 
model. These data suggest that FRAX score may not be a robust surrogate for 
falls risk and that inclusion of falls in fracture risk assessment should be 
further explored.