title: High fracture probability with FRAX usually indicates densitometric osteoporosis: implications for clinical practice.
abstract: 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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  A FRAX designation of high risk of fracture is usually associated with a densitometric diagnosis of osteoporosis.
authors.affiliation: University of Manitoba, Winnipeg, Canada. bleslie@sbgh.mb.ca
authors.forename: W D
authors.initials: WD
authors.lastname: Leslie
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
authors.forename: H
authors.initials: H
authors.lastname: Johansson
authors.forename: A
authors.initials: A
authors.lastname: Oden
authors.forename: E
authors.initials: E
authors.lastname: McCloskey
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology