METABOLIC BONE DISEASE: Edited by Christian RouxFRAX updates 2016McCloskey, Eugene V.a,b; Harvey, Nicholas C.c; Johansson, Helenaa; Kanis, John A.aAuthor Information aCentre for Metabolic Bone Diseases bCentre for Integrated Research Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield cMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Correspondence to Professor Eugene V. McCloskey, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. E-mail: E.V.McCloskey@sheffield.ac.uk Current Opinion in Rheumatology: July 2016 - Volume 28 - Issue 4 - p 433-441 doi: 10.1097/BOR.0000000000000304 Buy Metrics Abstract Purpose of review In the 8 years since the launch of the FRAX tool, it has continued to grow with the addition of new country or territory models. Although the core of the fracture risk algorithm remains unchanged, there is growing evidence of possible additional independent clinical variables that might modulate the interpretation of the FRAX outputs. There is also an expanding number of international guidelines that incorporate FRAX assessments, leading to discussions on the use of FRAX in treated patients and the determination of intervention thresholds. Recent findings This review encompasses recent information on the use of FRAX in immigrant populations and the potential influence of skeletal and extraskeletal risk factors on FRAX estimations. For example, trabecular bone score and falls risk appear to be promising additional factors in individual risk assessment. FRAX appears to remain accurate in those on osteoporosis treatments, but FRAX is not a suitable tool for use in treat-to-target strategies. Summary The assessment of fracture risk in immigrants is probably more accurate with the use of the FRAX tool for the country of origin, if available. The impact of additional risk variables will need evaluation of the impact of these on recharacterizing patients by moving them across intervention thresholds. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.