The overall diagnosis and treatment rate of osteoporotic fractures is low in our county, and there is an urgent need to find reliable prediction tools. FRAX is a predictive tool recommended by Guidelines for the Diagnosis and Treatment of Primary Osteoporosis, but its predictive value and intervention threshold in the Chinese population need to be further verified.

To evaluate the predictive value of FRAX on fracture risk in Beijing residents and explore the intervention threshold.

One thousand and eighteen participants were randomly recruited from four community health service centers in Beijing during the period between 2011 and 2012. Based on the FRAX tool, the probability of major osteoporotic fracture (MOF) and hip fracture (HF) in the next 10 years were calculated for each participant. Osteoporotic fractures that occurred during the 10-year research period were self-reported, collected from 2021 to 2022. Taking the actual occurrence of fractures as the gold standard, the receiver operating characteristic (ROC) curve of FRAX for predicting fractures was drawn; the area under the curve (AUC) was analyzed for the predictive value of FRAX on fracture and the intervention threshold was explored.

Four hundred and sixty-nine subjects were followed up successfully. The median probability of MOF and HF calculated by FRAX were 2.6% (2.2%, 3.7%) and 0.5% (0.3%, 0.9%), respectively. A total of 49 (10.45%) new MOF were occurred during the 10 years, of which 5 (1.07%) were HF. ROC analysis showed the AUCs of FRAX and femoral neck bone mineral density were 0.683 and 0.662, respectively. The cut-off value at which Yoden's index is maximum was 2.95% with a sensitivity of 59.2% and a specificity of 67.6%.

The FRAX tool has certain predictive power for future fractures, whereas there is still room for improvement. To predict major osteoporotic fractures, the probability of FRAX-MOF is 2.95%, which is the maximum cutoff value of Yoden's Index. It can be considered as a reference for formulating intervention thresholds.

我国骨质疏松性骨折的整体诊治率偏低，迫切需要寻找可靠的预测工具。FRAX是我国骨质疏松诊疗指南推荐的预测工具，但其在中国内地人群中的预测价值和干预阈值尚待进一步验证。

评估FRAX对北京地区居民骨折风险的预测价值，并探讨干预阈值。

于2011—2012年在北京市4家社区卫生服务中心招募受试者1 018名，基于FRAX计算每名受试者未来10年的主要部位骨折（MOF）风险和髋部骨折（HF）风险；于2021—2022年对受试者进行随访，获取其自我报告的10年间骨折发生情况。以骨折实际发生情况为"金标准"，绘制FRAX预测骨折的受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评价FRAX对北京地区居民的骨折风险预测价值，并探讨干预阈值。

成功回访受试者469名（46.07%），利用FRAX计算的中位MOF概率为2.6%（2.2%，3.7%），中位HF概率为0.5%（0.3%，0.9%），49名（10.45%）在10年间发生MOF，其中5名（1.07%）为HF。ROC曲线分析显示，FRAX和单纯股骨颈骨密度（BMD）预测MOF的AUC分别为0.683和0.662。约登指数最大时的截断值为2.95%，灵敏度为59.2%，特异度为67.6%。

FRAX对未来骨折有一定的预测能力，但仍有改进空间。预测MOF概率为2.95%时为约登指数最大的截断值，可作为制定干预阈值的参考。