10-year fracture risk

Your T-score tells you how your bone density compares to a healthy young adult, but it doesn't capture the whole picture. Two people with the same T-score can have very different real-world chances of breaking a bone, depending on their age, sex, body size, past fractures, family history, smoking, alcohol use, and certain medical conditions or medications. A 10-year fracture risk estimate pulls all of that together into one number.

The most widely used way to calculate this is a tool called FRAX, which combines femoral neck bone density with these clinical risk factors to estimate your probability of a major osteoporotic fracture (spine, hip, wrist, or shoulder) and separately your probability of a hip fracture over the next 10 years. Doctors often use these numbers, alongside guidelines in their country, to help decide whether treatment is worth discussing.

It's important to know this tool has real limits. It can underestimate risk for people who've had a recent fracture, have type 2 diabetes, fall frequently, have multiple spine fractures, or take high-dose steroids. It also only uses femoral neck density, not the spine, and treats risk factors as simply present or absent rather than accounting for severity. Because of this, your doctor should treat the result as a useful starting point for conversation, not the final word, and consider your full history alongside it.