Osteoporosis International

, Volume 23, Issue 1, pp 391–397

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

  • W. D. Leslie
  • S. R. Majumdar
  • L. M. Lix
  • H. Johansson
  • A. Oden
  • E. McCloskey
  • J. A. Kanis
  • for the Manitoba Bone Density Program
Short Communication



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 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • W. D. Leslie
    • 1
    • 7
  • S. R. Majumdar
    • 2
  • L. M. Lix
    • 3
  • H. Johansson
    • 4
  • A. Oden
    • 4
  • E. McCloskey
    • 5
  • J. A. Kanis
    • 6
  • for the Manitoba Bone Density Program
  1. 1.University of ManitobaWinnipegCanada
  2. 2.University of AlbertaEdmontonCanada
  3. 3.University of SaskatchewanSaskatoonCanada
  4. 4.GothenburgSweden
  5. 5.Osteoporosis CentreNorthern General HospitalSheffieldUK
  6. 6.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  7. 7.Department of Medicine (C5121)St. Boniface General HospitalWinnipegCanada

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