Introduction 1 1 2 3 4 5 3 6 7 8 Against this background, additional aims of the present study were to provide fracture probabilities based on the FRAX™ tool that were equivalent to currently accepted intervention thresholds, explore the impact of using Japanese-specific normative data for femoral neck BMD, and reassess the respective performance characteristics of BMD at the femoral neck and lumbar spine. Methods 9 1 10 11 12 3 4 13 14 7 15 11 2 16 2 17 7 Results Ten-year probability of fracture 1 Fig. 1 Ten-year probability (%) of osteoporotic fracture (hip, clinical spine, humerus, forearm) in Japanese men and women without clinical risk factors according to age and T-score for BMD at the femoral neck  2 2 2 Fig. 2 2  3 3 Fig. 3 Ten-year probability of osteoporotic (hip, clinical spine, humerus, forearm) and hip fracture based on women at the threshold for the diagnosis of osteoporosis using the criteria of the Japanese Bone Mineral Metabolism Association  Comparison of lumbar spine and femoral neck BMD 1 2 1 Table 1 Predictive ability of spine and femoral neck BMD for any, osteoporotic and hip fracture in men and women from Japan   RR/SD 2 RR 95% CI RR 95% CI a. Any fracture Femoral neck 1.45 1.23–1.70 1.43 1.22–1.68 Lumbar spine 1.25 1.13–1.39 1.38 1.19–1.61 b. Osteoporosis-related fractures Femoral neck 1.40 1.09–1.78 1.38 1.09–1.74 Lumbar spine 1.20 1.04–1.40 1.30 1.05–1.61 c. Hip fracture Femoral neck b 1.34–3.22 2.11 1.38–3.23 Lumbar spine 1.17 0.91–1.50 1.25 0.87–1.80 a b Japanese reference values 2 2 2 2 2 2 2 2 4 Fig. 4 2  Discussion 1 10 11 18 12 19 13 6 20 22 3 11 23 24 13 25 26 11 16 15 27 In conclusion, a FRAX™ tool has been developed to compute fracture probabilities calibrated to the epidemiology of Japan. The tool has been used to determine possible thresholds for therapeutic intervention, based on equivalence of risk with current guidelines. The approach will need to be supported by appropriate health economic analyses. The present study indicates that the femoral neck BMD is suitable for prediction of the risk for fracture among Japanese people. However, when applying the FRAX™ model to Japan, T-scores and Z-scores should be converted into those derived from the international reference.