Short Communication

Osteoporosis International

, Volume 23, Issue 1, pp 391-397

First online:

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

  • W. D. LeslieAffiliated withUniversity of ManitobaDepartment of Medicine (C5121), St. Boniface General Hospital Email author 
  • , S. R. MajumdarAffiliated withUniversity of Alberta
  • , L. M. LixAffiliated withUniversity of Saskatchewan
  • , H. JohanssonAffiliated with
  • , A. OdenAffiliated with
  • , E. McCloskeyAffiliated withOsteoporosis Centre, Northern General Hospital
  • , J. A. KanisAffiliated withWHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield
  • , for the Manitoba Bone Density Program

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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 density Clinical risk factors Fracture prediction FRAX® Osteoporosis