Osteoporosis International

, Volume 23, Issue 1, pp 391–397

High fracture probability with FRAX® usually indicates densitometric osteoporosis: implications for clinical practice


    • University of Manitoba
    • Department of Medicine (C5121)St. Boniface General Hospital
  • S. R. Majumdar
    • University of Alberta
  • L. M. Lix
    • University of Saskatchewan
  • H. Johansson
  • A. Oden
  • E. McCloskey
    • Osteoporosis CentreNorthern General Hospital
  • J. A. Kanis
    • WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield
  • for the Manitoba Bone Density Program
Short Communication

DOI: 10.1007/s00198-011-1592-3

Cite this article as:
Leslie, W.D., Majumdar, S.R., Lix, L.M. et al. Osteoporos Int (2012) 23: 391. doi:10.1007/s00198-011-1592-3



Most patients designated as high risk of fracture using fracture risk assessment tool (FRAX®) with femoral neck bone mineral density (BMD) (i.e., 10-year major osteoporotic fracture probability exceeding 20% or hip fracture exceeding 3%) have one or more T-scores in the osteoporotic range; conversely, almost no high risk patients have normal T-scores at all bone mineral density measurement sites.


We determined the agreement between a FRAX® designation of high risk of fracture [defined as 10-year major osteoporotic fracture probability (≥20%) or hip fracture probability (≥3%)] and the WHO categorizations of bone mineral density according to T-score.


Ten-year FRAX® probabilities calculated with femoral neck BMD were derived using both Canadian and US white tools for a large clinical cohort of 36,730 women and 2,873 men age 50 years and older from Manitoba, Canada. Individuals were classified according to FRAX fracture probability and BMD T-scores alone.


Most individuals designated by FRAX as high risk of major osteoporotic fracture had a T-score in the osteoporotic range at one or more BMD measurement sites (85% with Canadian tool and 83% with US white tool). The majority of individuals deemed at high risk of hip fracture had one or more T-scores in the osteoporotic range (66% with Canadian tool and 64% with US white tool). Conversely, there were extremely few individuals (<1%) who were at high risk of major osteoporotic or hip fracture with normal T-scores at all BMD measurement sites.


A FRAX designation of high risk of fracture is usually associated with a densitometric diagnosis of osteoporosis.


Bone mineral densityClinical risk factorsFracture predictionFRAX®Osteoporosis

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011