Osteoporotic fractures are a major health problem in older people, affecting one in two women and one in five men over 50. These fractures are associated with significant morbidity and increased mortality, and cost the health services an estimated £1.8 billion annually. Recently, it has been shown that prediction of fracture risk can be improved by the use of clinical risk factors independent of BMD. These risk factors, alone or in combination with BMD measurement, form the basis of the WHO-supported FRAX tool for predicting fracture risk. This is available free online at www.shef.ac.uk/frax and can be used to assess the 10-year probability of a patient developing a major osteoporotic fracture (wrist, spine, hip and humerus) or hip fracture.