National Health Statistics Reports
 

Number 103  March 28, 2017 

FRAX-based Estimates of 10-year Probability of Hip 

and Major Osteoporotic Fracture Among Adults Aged 

40 and Over: United States, 2013 and 2014 

by Anne C. Looker, Ph.D., and Neda Sarafrazi Isfahani, Ph.D., National Center for Health Statistics; and Bo Fan, M.D., 

and John A. Shepherd, Ph.D., University of California, San Francisco 

Abstract 

Background—The FRAX algorithm estimates the 10-year probability of hip and 

major osteoporotic (clinical spine, forearm, hip, or humerus) fracture for adults aged 

40 and over. An expert panel developed criteria to define elevated FRAX probabilities 

for U.S. adults aged 50 and over. This report uses FRAX estimates from the National 

Health and Nutrition Examination Survey 2013–2014 to describe the hip and major 

osteoporotic fracture probability distribution (for adults aged 40 and over) and 

prevalence of elevated probabilities (for adults aged 50 and over) in the United States. 

Methods—FRAX U.S. version 3.05 was used to calculate fracture probability 

from risk factors that were measured (i.e., femur neck bone mineral density, height, 

and weight) or self-reported (i.e., fracture history, glucocorticoid use, rheumatoid 

arthritis, smoking, and alcohol intake). Among adults aged 50 and over, elevated 

probabilities were defined as 3% or greater for hip fracture and 20% or greater for 

major osteoporotic fracture.

 Results—Mean skew-adjusted fracture probabilities were 0.5% for hip fracture 

and 5.3% for major osteoporotic fracture among adults aged 40 and over, and 0.9% 

and 7.4%, respectively, among adults aged 50 and over. The percentages of adults 

aged 50 and over with an elevated hip or major osteoporotic fracture probability 

were 19% and 8%, respectively. Fracture probabilities varied significantly by age 

(older groups had higher probabilities than younger groups), sex (women had higher 

probabilities than men), and race and Hispanic origin (non-Hispanic white persons had 

higher probabilities than all other race and Hispanic groups) (p < 0.001). An estimated 

95%–97% of adults aged 50 and over with an elevated probability of either fracture 

type had femoral neck osteoporosis or low bone mass. 

Conclusions—Mean hip and major osteoporotic fracture probabilities were 0.5% 

and 5.3%, respectively, for adults aged 40 and over. Among adults aged 50 and over, 

mean hip and major osteoporotic fracture probabilities were 0.9% (19% with elevated 

values) and 7.4% (8% with elevated values), respectively. 

Keywords: fracture risk prediction • osteoporosis • National Health and Nutrition 

Examination Survey (NHANES) 

Introduction 

Fractures due to osteoporosis are a 

serious concern in the United States due 

to their economic burden as well as their 

negative impact on health and well-being 

(1,2). Osteoporosis is currently defined on 

the basis of bone mineral density (BMD) 

(3) because BMD is a strong predictor of 

future fracture. However, many fractures 

occur in persons with BMD values that 

fall above the osteoporosis threshold (2). 

Thus, measuring BMD only partially 

identifies the population segment who are 

at risk of fracture. 

To address this discrepancy, 

researchers at the World Health 

Organization (WHO) Collaborating 

Centre at Sheffield, United Kingdom, in 

the early 2000s developed a more global 

evaluation of fracture risk than that based 

on BMD alone (4). As part of the effort, 

a number of clinical risk factors that 

predict fracture independently of BMD 

(e.g., lifestyle and health history risk 

factors easily assessed in primary care 

settings) were identified and validated 

using data from a large number of 

international, prospective populationbased cohorts (4). An algorithm, called 

FRAX, was then developed to integrate 

these risk factors with mortality data to 

estimate the 10-year absolute probability 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Health Statistics
 
Page 2 National Health Statistics Reports  Number 103  March 28, 2017 

of hip and major osteoporotic (clinical 

spine, forearm, hip, or humerus) fracture 

among adults aged 40 and over (4). Risk 

factors used in the algorithm include age, 

sex, femur neck BMD, body mass index 

(BMI), prior fragility fracture, parental 

history of hip fracture, glucocorticoid 

use, rheumatoid arthritis, current 

smoking, excess alcohol consumption, 

and secondary osteoporosis. Separate 

FRAX algorithms have been developed 

for different countries using countryspecific fracture and mortality data (4). 

The U.S. Food and Drug Administration 

has approved incorporating the FRAX 

algorithm into dual energy X-ray 

absorptiometry (DXA) systems so that 

FRAX estimates can be provided in 

addition to BMD results when DXA 

scans are performed (5–7). FRAX-based 

10-year fracture probability estimates 

are currently used in many national and 

international osteoporosis guidelines 

(5,8), including several guidelines used 

in the United States (9–12). One of 

these U.S. guidelines, developed by the 

National Osteoporosis Foundation on the 

basis of a cost-effective analysis, includes 

criteria to define elevated fracture 

probabilities applicable to U.S. adults 

aged 50 and over (9). 

Although FRAX-based estimates of 

10-year fracture probabilities, or FRAX 

scores, are widely used in the United 

States, the distribution of these fracture 

probability scores among the adult U.S. 

population has not been previously 

described. This report provides detailed 

information about the FRAX score 

distribution for U.S. adults aged 40 

and over using data from the National 

Health and Nutrition Examination Survey 

(NHANES) conducted in 2013 and 2014. 

Information on the prevalence of the 

risk factors used in the FRAX algorithm 

among adults aged 40 and over, and the 

prevalence of elevated FRAX scores 

among adults aged 50 and over, are also 

provided. 

Methods 

Data source 

The present study used data 

collected in NHANES 2013–2014, 

which was conducted by the National 

Center for Health Statistics (NCHS) 

to assess the health and nutritional 

status of a representative sample of 

the noninstitutionalized, civilian U.S. 

population. A complex, multistage 

probability sample design was used to 

select the sample (13,14). NHANES 

collects data via household interviews 

and direct standardized physical 

examinations conducted in specially 

equipped mobile examination centers 

(14). All procedures in NHANES 

2013–2014 were approved by the NCHS 

Research Ethics Review Board, and 

written informed consent was obtained 

from all participants. The unweighted 

examination response rate for adults 

aged 40 and over, the age range for 

which 10-year fracture probability scores 

were calculated, was 61% for NHANES 

2013–2014. 

The analytic sample was derived 

from the 3,708 adults aged 40 and over 

participating in NHANES 2013–2014 

who received physical examinations. 

Of these, 581 (15.67%) were excluded 

because they lacked valid femur neck 

BMD, height, or weight data. The final 

main analytic sample consisted of 3,127 

respondents. 

Measures 

BMD 

Proximal femur scans were 

obtained via DXA using Hologic 

Discovery A densitometers (Hologic 

Inc., Marlborough, Mass.) in NHANES 

2013–2014. The femur scans were 

analyzed with Apex 4.0 software. Details 

of the DXA examination protocol have 

been published elsewhere (15). Rigorous 

quality control (QC) programs were 

used to monitor DXA scanners. All QC 

and respondent scans were analyzed and 

reviewed by an expert at a central site 

(Department of Radiology at University 

of California, San Francisco [UCSF]) 

using standard radiologic techniques and 

study-specific protocols developed for 

NHANES (15). 

Femur neck BMD of adults aged 50 

and over was categorized as normal, low 

bone mass, or osteoporosis using criteria 

recommended by WHO (16). T scores 

were calculated as: 

BMDrespondent – mean BMDreference group 

Standard deviationreference group 

Normal was defined as a T score 

greater than –1.0; low bone mass as 

a T score between –1.0 and –2.5; and 

osteoporosis as a T score of –2.5 or less. 

Based on WHO recommendations, 

non-Hispanic white women aged 

20–29 who participated in NHANES III 

(1988–1994) were used as the reference 

group for calculation of T scores at the 

femur neck (16). 

Anthropometry 

Body weight was measured to the 

nearest 0.01 kg using an electronic 

load cell scale, and standing height 

was measured with a fixed stadiometer. 

BMI was calculated as body weight 

(kilograms) divided by height (meters 

squared). 

Clinical risk factors 

The lifestyle and health history risk 

factors used to calculate the 10-year 

fracture probability scores, referred to as 

“clinical risk factors” by developers of 

the FRAX approach (4), were measured 

as follows: 

● Previous fracture: Two data

sources were used to define previous

fractures: a) self-reported fractures

at any skeletal site that occurred

after age 20; and b) presence of a

vertebral fracture on the respondent’s

Vertebral Fracture Assessment 

obtained via a lateral spine DXA

scan performed on the Hologic

Discovery A densitometer. Each

vertebra between the fourth thoracic

vertebra (T4) and the fourth lumbar

spine vertebra (L4) was graded by

a reader at the UCSF DXA QC site

using Genant’s semiquantitative

method (17). Fractured vertebrae

were confirmed by an expert

musculoskeletal radiologist
National Health Statistics Reports  Number 103  March 28, 2017	 Page 3 

(Dr. Harry Genant). Respondents 

with vertebral fractures were defined 

using an approach recommended for 

NHANES 2013–2014 by an expert 

group (18). Specifically, a respondent 

was defined as “fractured” if a 

fracture was observed anywhere 

between T4 and L4, regardless 

if unevaluable vertebrae existed 

elsewhere. Respondents were defined 

as “not fractured” if no fracture 

was observed and at least 9 of 10 

vertebrae between T7 and L4 were 

evaluable. T4–T6 were not required 

to be evaluable because they are 

difficult to visualize correctly and 

only a small proportion of vertebral 

fractures occur at these levels (19). 

Status was listed as “uninterpretable” 

for respondents not meeting these 

criteria. 

●	 Parental history of hip fracture:

Respondents who reported that either

their biological mother or father had

fractured their hip were considered

to have a positive parental history.

●	 Cigarette smoking and high

alcohol intake: Cigarette smokers

were defined as respondents who

self-reported that they currently

smoked, while high alcohol users

were defined as respondents who

self-reported that they usually

consumed three or more drinks per

day when they drank alcohol, for

consistency with the approach used

for this variable in the FRAX model.

●	 Glucocorticoid use: Usage was

based on self-report of having ever

taken prednisone or cortisone nearly

every day for 90 days or more.

●	 Rheumatoid arthritis (RA):

Persons with RA were defined as

those who self-reported having been

told by a doctor that they had RA.

●	 Other causes of secondary

osteoporosis: These were not

included in the calculation of the

10-year fracture probability scores

because they do not affect the scores

when BMD is in the algorithm (4).

Thus, this variable was recorded as

“no” for all respondents.

FRAX-based estimates of 

10-year fracture probability 

Ten-year probability scores were 

calculated for hip and major osteoporotic 

fractures (involving hip, spine, proximal 

humerus, or distal forearm) using FRAX 

version 3.05 for the United States, 

which was available on the Hologic 

DXA system. This version provides 

separate algorithms for Caucasian, black, 

Hispanic, and Asian persons. Persons 

of other races were analyzed using the 

Caucasian algorithm in the present 

study. Race and Hispanic origin were 

self-reported by the participants. Persons 

with missing data for a clinical risk 

factor were assumed not to have that risk 

factor, as recommended on the FRAX 

website: http://www.shef.ac.uk/FRAX. 

Elevated 10-year fracture probability 

scores were defined for respondents 

aged 50 and over in the present study 

using thresholds for intervention 

with osteoporosis medications that 

were recommended in the National 

Osteoporosis Foundation (NOF) 

guidelines for persons in this age range 

(9). An elevated 10-year probability 

score was defined as 3% or more for 

hip fracture and 20% or more for major 

osteoporotic fracture. These thresholds 

were based on a cost–benefit analysis 

that was performed to identify the 

10-year fracture probability values 

required for osteoporosis treatments to 

be cost-effective for adults aged 50 and 

over in the United States (20,21). 

Statistical analysis 

Analyses were conducted with 

PC–SAS Version 9.3 (SAS Institute, Cary, 

N.C.) and SUDAAN Version 11.0.1 (RTI 

International, Research Triangle Park, 

N.C.). All analyses used the examination 

sample weights and accounted for the 

complex survey design when calculating 

statistical tests. Because the distributions 

of the 10-year probability scores for both 

hip and major osteoporotic fractures were 

skewed, the fracture probability scores 

were transformed before comparing means 

by age, sex, or race and Hispanic origin. 

Transformations were identified using 

Box-Cox analyses. Based on those results, 

hip fracture probability scores were raised 

to the fourth power, while a natural log 

transformation was used for the major 

osteoporotic fracture probability scores. 

The transformed data were then backtransformed for presentation as means 

in the tables and figures. Specifically, 

transformed hip fracture probability values 

were raised to the one-fourth power, 

while the antilog of transformed major 

osteoporotic fracture probability values 

was used to calculate the geometric mean. 

Age-adjusted estimates shown in the 

detailed tables were age-adjusted to the 

2000 census using the direct method and 

the following age groups: 40–49, 50–59, 

60–69, 70–79, and 80 and over. Tests of 

statistical significance were performed 

using linear or logistic regression. 

Missing data 

Nonresponse bias analyses were 

conducted because 16% of the examined 

sample of adults aged 40 and over in 

NHANES 2013–2014 had been excluded 

from the main analytic sample due to 

missing femur neck BMD, height, or 

weight data. Excluded respondents were 

more likely to be female, older, shorter, 

weigh more, have a higher BMI, and 

self-reported their health status as fair 

or poor than respondents in the analytic 

sample. To further examine the potential 

for nonresponse bias, the publicly 

released examination sample weights 

were adjusted for item nonresponse using 

the PROC WTADJUST procedure in 

SUDAAN. This model-based calibration 

procedure was used to reweight the 

data by computing nonresponse and 

poststratification weight adjustments by 

age, sex, and race and Hispanic origin 

in order to adjust for biases associated 

with these variables. The adjusted sample 

weights resulted in similar conclusions 

to those seen when the publicly released 

examination sample weights were used; 

thus, only the latter results are shown. 
Page 4 National Health Statistics Reports  Number 103  March 28, 2017 

Results 

Population distribution of 

characteristics used in 

FRAX algorithms for ages 

40 and over 

Means and percentages of the 

characteristics used in the FRAX 

algorithms to calculate 10-year 

probability of hip and major osteoporotic 

fracture are shown in Table A for adults 

aged 40 and over from NHANES 

2013–2014 by sex and as a total. 

Comparisons by race and Hispanic origin 

are not shown because sample sizes for 

the nonwhite groups were insufficient to 

provide statistically reliable estimates for 

many of the clinical risk factors. 

Mean age was approximately 

57 years, and mean BMI was roughly 

29 kg/m2

 for adults aged 40 and over. 

Women were significantly older 

than men. Mean BMI did not differ 

significantly between men and women. 

However, mean femur neck BMD was 

significantly lower in women than in 

men, by 0.07 gm/cm2, which corresponds 

to approximately 0.6 standard deviation 

units, or roughly a 27% difference in 

fracture risk (4). 

Previous fracture (35%) was the 

most common clinical risk factor reported 

overall by adults aged 40 and over in 

2013–2014, followed by drinking alcohol 

three or more times per day (19%) and 

current smoking (18%) (Table A). All 

other clinical risk factors used in the 

FRAX algorithms were reported by 9% or 

less of these adults. The majority of adults 

in this age range (59%) reported having at 

least one of the clinical risk factors, with 

6% reporting having three or more. The 

prevalence of the individual clinical risk 

factors, as well as the number of clinical 

risk factors, did not differ significantly 

between men and women with one 

exception: Men were significantly more 

likely than women to report consuming 

alcohol three times per day or more. 

Table A. Characteristics used to calculate FRAX-based 10-year hip and major osteoporotic fracture probability scores for adults aged 

40 and over: United States, 2013 and 2014 

Both sexes Men Women 

Sample Mean or Standard Sample Mean or Standard Sample Mean or Standard 

Characteristic size percent error size percent error size percent error 

Mean 

Mean age (years). . . . . . . . . . . . . . . 3,127 57.2 0.3 1,546 56.8 0.2 1,581 †

57.7 0.4 

Mean body mass 

index (kg/m2

) . . . . . . . . . . . . . . . . . 3,127 28.8 0.2 1,546 28.9 0.2 1,581 28.8 0.3 

Mean femur neck 

BMD (gm/cm2

) . . . . . . . . . . . . . . . . 3,127 0.779 0.003 1,546 0.815 0.004 1,581 †0.745 0.005 

Clinical risk factor (percent) 

Currently smoke: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 575 17.7 1.6 316 17.8 1.3 259 17.5 2.3 

No . . . . . . . . . . . . . . . . . . . . . . . . 2,552 82.3 1.6 1,230 82.2 1.3 1,322 82.5 2.3 

Drink three alcoholic drinks or 

more per day: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 541 18.6 0.7 387 26.5 1.3 154 †

10.9 1.0 

No . . . . . . . . . . . . . . . . . . . . . . . . 2,586 81.4 0.7 1,159 73.5 1.3 1,427 89.1 1.0 

Self-reported rheumatoid arthritis: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 161 4.6 0.4 65 3.7 0.6 96 5.4 0.8 

No . . . . . . . . . . . . . . . . . . . . . . . . 2,966 95.4 0.4 1,481 96.3 0.6 1,485 94.6 0.8 

Parent had a hip fracture: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 263 9.3 0.5 112 6.9 0.7 151 11.7 0.9 

No . . . . . . . . . . . . . . . . . . . . . . . . 2,864 90.7 0.5 1,434 93.1 0.7 1,430 88.3 0.9 

Glucocorticoid use for 3 months 

or more: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 103 3.3 0.5 40 2.3 0.6 63 4.3 0.5 

No . . . . . . . . . . . . . . . . . . . . . . . . 3024 96.7 0.5 1,506 97.7 0.6 1,518 95.7 0.5 

Previous fracture1

: 

Yes . . . . . . . . . . . . . . . . . . . . . . . . 963 34.7 1.6 489 35.3 2.2 474 34.2 1.4 

No . . . . . . . . . . . . . . . . . . . . . . . . 2,164 65.3 1.6 1,057 64.7 2.2 1,107 65.8 1.4 

Number of clinical risk factors: 

None . . . . . . . . . . . . . . . . . . . . . . 1,385 40.9 1.2 625 38.6 1.4 760 43.1 1.6 

One . . . . . . . . . . . . . . . . . . . . . . . 1,084 36.6 1.0 556 37.3 1.3 528 35.9 1.1 

Two. . . . . . . . . . . . . . . . . . . . . . . . 470 16.6 0.8 253 18.0 1.4 217 15.2 0.8 

Three or more . . . . . . . . . . . . . . . 188 6.0 1.0 112 6.1 1.0 76 5.8 1.0 

†

 Significantly different from men, p < 0.05.
 1

Based on self-reported fractures and vertebral fractures measured via Vertebral Fracture Assessment from lateral dual-energy X-ray absorptiometry spine scans.
 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 years. It is based on age, sex, race and Hispanic origin, femur neck bone 


mineral density, body mass index, smoking, alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. BMD is bone mineral density.
 
 

National Health Statistics Reports  Number 103  March 28, 2017	 Page 5 

Population distribution of 	 fracture were 5.3% for adults aged 40 

and over and 7.4% for adults aged 50 and FRAX-based estimates of 

over (Table 2). Approximately 2.5% of 10-year probability of hip or adults aged 40 and over had a 10-year hip major osteoporotic fracture fracture probability equal to zero (data for ages 40 and over not shown). 

Means (arithmetic and back- A comparison of adjusted, backtransformed mean fracture probabilities transformed) and percentile values for for adults aged 40 and over by age, sex, the 10-year fracture probability estimates and race and Hispanic origin is shown in adults aged 40 and over are shown by in Table B for both fracture types. detailed age, sex, and race and Hispanic- After adjusting for sex and race and origin categories for hip fracture in Hispanic origin, mean back-transformed Table 1 and for major osteoporotic hip and major osteoporotic fracture fracture in Table 2. Results in the 

probabilities increased significantly detailed tables for non-Hispanic black, with age. After adjusting for age and Hispanic, non-Hispanic Asian, and other race and Hispanic origin, mean back- race groups are not shown by decade transformed probability estimates were because sample sizes were insufficient also significantly higher in women than to provide statistically reliable estimates in men, by 0.1 percentage point for hip for a majority of the age groups. The fracture and 2 percentage points for back-transformed mean for the 10-year major osteoporotic fracture. Finally, probability of hip fracture in the United mean back-transformed hip and major States was 0.5% for adults aged 40 and osteoporotic fracture probabilities over and 0.9% for adults aged 50 and differed significantly by race and over (Table 1). Geometric means for the Hispanic origin after adjusting for age 10-year probability of major osteoporotic 

Table B. Adjusted mean FRAX-based 10-year probability of hip and major osteoporotic 

fracture among adults aged 40 and over, by sex, age, and race and Hispanic origin: 

United States, 2013 and 2014 

Major osteoporotic fracture 

Hip fracture probability probability 

Sex, age, and race and Sample Standard Standard 

Hispanic origin size Mean error Mean error 

Sex 

Men . . . . . . . . . . . . . . . . . . . . . 1,546 0.45 0.003 4.38 0.06 

Women . . . . . . . . . . . . . . . . . . 1,581 0.59 0.011 6.29 0.12 

p value. . . . . . . . . . . . . . . . . . . ... < 0.001 ... < 0.001 ... 

Age group (years) 

40–49. . . . . . . . . . . . . . . . . . . . 897 0.10 0.00004 2.59 0.04 

50–59. . . . . . . . . . . . . . . . . . . . 784 0.38 0.003 5.54 0.15 

60–69. . . . . . . . . . . . . . . . . . . . 788 0.86 0.036 7.77 0.18 

70–79. . . . . . . . . . . . . . . . . . . . 428 *2.41 *1.100 9.57 0.22 

80 and over . . . . . . . . . . . . . . . 230 ** ** 11.35 0.35 

p value, linear trend. . . . . . . . . ... < 0.001 ... < 0.001 ... 

Race and Hispanic origin 

Non-Hispanic white . . . . . . . . . 1,374 †

0.67 0.013 †6.59 0.11 

Non-Hispanic black . . . . . . . . . 626 †

0.11 0.00005 †2.25 0.05 

Hispanic. . . . . . . . . . . . . . . . . . 693 †

0.29 0.001 ‡3.23 0.08 

Non-Hispanic Asian . . . . . . . . . 365 †

0.42 0.005 §3.35 0.08 

p value. . . . . . . . . . . . . . . . . . . ... < 0.001 ... < 0.001 ... 

... Category not applicable. 

* Figure does not meet standards of reliability or precision; standard error / estimate is between 30% and 49% or estimate is based 


on less than 12 degrees of freedom.
 

** Figure does not meet standards of reliability or precision; standard error / estimate is greater than 50%.
 

†

 Significantly different from all other race and Hispanic-origin groups, p < 0.05.
 ‡

 Significantly different from all other race and Hispanic-origin groups except non-Hispanic Asian, p < 0.05.
 §

 Significantly different from all other race and Hispanic-origin groups except Hispanic, p < 0.05.
 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 years. It is 

based on age, sex, race and Hispanic origin, femur neck bone mineral density, body mass index, smoking, alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. Means for each demographic characteristic have been 

adjusted for the other demographic characteristics shown in the table. 

and sex. The 10-year probability for 

both fracture types differed significantly 

between non-Hispanic white persons 

and the other race and Hispanic-origin 

groups, by 0.3–0.6 percentage points 

for hip fracture and 3–4 percentage 

points for major osteoporotic fracture. 

The probability of hip fracture was 

significantly higher in non-Hispanic 

Asian persons compared with Hispanic 

persons, but the probability of major 

osteoporotic fracture did not differ 

between these two groups. 

Prevalence of elevated 

10-year probability of hip or 

major osteoporotic fracture 

by age, sex, and race and 

Hispanic origin for ages 

50 and over 

The prevalence of adults aged 50 

and over having a 10-year hip fracture or 

major osteoporotic fracture probability 

that exceeds the intervention thresholds 

defined by NOF guidelines (9) is shown 

in Table C. This analysis focuses on 

adults aged 50 and over because NOF 

criteria were defined for that age range. 

Overall, approximately 19% of adults 

aged 50 and over had a hip fracture 

probability that was 3% or more, and 

8% had a major osteoporotic fracture 

probability that was 20% or more. 

After adjusting for age, the 

proportion with elevated 10-year hip and 

major osteoporotic fracture probabilities, 

as defined by NOF criteria (9), was 

two to seven times higher in women 

than in men (p < 0.001) (Table C). The 

unadjusted prevalence of elevated 

10-year probability of both fracture types 

also increased significantly with age 

(p < 0.001). Specifically, the unadjusted 

prevalence of elevated hip fracture 

probability increased from 7% among 

those aged 50–59 to 72% in those aged 

80 and over. The unadjusted prevalence 

of elevated major osteoporotic fracture 

probability increased from 3% in the 

youngest age group to 27% in the oldest 

age group. Finally, age-adjusted 10-year 

fracture probabilities were significantly 

higher in non-Hispanic white persons 

than in other race and Hispanic-origin 

groups for both fracture types 

(p < 0.001). 
Page 6 National Health Statistics Reports  Number 103  March 28, 2017 

Table C. Prevalence of elevated FRAX-based 10-year probability of hip or major osteoporotic fracture among adults aged 50 and over, by 

sex, age, and race and Hispanic origin: United States, 2013 and 2014 

Hip fracture probability Major osteoporotic fracture 

3% or more probability 20% or more 

Sex, age, and race Sample Standard Age-adjusted Standard Age-adjusted 

and Hispanic origin size Percent error percent Percent error percent 

Total: 2,230 18.9 1.08 22.6 8.3 0.49 9.6 

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,111 12.9 1.00 16.6 2.2 0.50 2.3 

Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,119 24.7 1.99 †

27.4 14.1 0.85 †15.5 

Age group (years): 

50–59. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 784 6.7 0.85 ... 2.9 0.81 ... 

60–69. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 788 11.3 1.60 ... 6.4 1.15 ... 

70–79. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428 38.6 3.05 ... 16.1 3.38 ... 

80 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 71.6 2.47 ... 27.4 1.89 ... 

Race and Hispanic origin: 

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,029 22.8 1.42 25.5 10.6 0.70 11.6 

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 *2.8 1.13 *‡

4.8 ** ** **

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 5.6 1.19 ‡

10.7 *1.0 0.44 *‡1.8 

Non-Hispanic Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 11.6 1.95 ‡

16.0 ** ** **

†

 Significantly different from men, p < 0.05.
 

... Category not applicable.
 

* Figure does not meet standards of reliability or precision; standard error / estimate is between 30% and 49% or estimate is based on less than 12 degrees of freedom.
 

‡

 Significantly different from non-Hispanic white, p < 0.05.
 

** Figure does not meet standards of reliability or precision; standard error / estimate is greater than 50%.
 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 years. It is based on age, sex, race and Hispanic origin, femur neck bone mineral density, body mass index, smoking, alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. 

The femur neck status of adults aged 

50 and over with elevated 10-year hip or 

major osteoporotic fracture probabilities 

is shown in Figure 1. Between 95% and 

97% of adults aged 50 and over with an 

elevated probability of either fracture 

type had poor status at the femur neck. 

Among adults with an elevated hip 

fracture probability, 67% had low bone 

mass, and 30% had osteoporosis at the 

femur neck. Corresponding values for 

those with elevated major osteoporotic 

fracture probability were 53% with low 

bone mass and 42% with osteoporosis at 

the femur neck. 

The agreement in hip and major 

osteoporotic fracture risk status as 

defined by the NOF criteria among adults 

aged 50 and over is shown in Figure 2. 

Status agreed for 89% of older adults 

overall: 81% did not have an elevated 

risk for either fracture type, and 8% had 

an elevated risk for both fracture types. 

Those with discordant status were almost 

exclusively limited to adults with an 

elevated probability of hip fracture only 

(11%); less than 1% had an elevated 

probability of major osteoporotic fracture 

alone. Approximately 50% of the adults 

with an elevated hip fracture probability 

alone had a major osteoporotic fracture 

probability of 15.0%–19.9% (data not 

shown). 

Discussion 

This report provides the first 

nationally representative estimates of 

FRAX-based 10-year probability of 

hip and major osteoporotic fracture for 

adults aged 40 and over in the United 

States for survey period 2013–2014. 

Estimates of the prevalence of elevated 

fracture probability in adults aged 50 and 

over, the group for which intervention 

thresholds have been defined, are also 

provided. After correcting for the skewed 

nature of the distribution, the average 

10-year probabilities of hip fracture and 

major osteoporotic fracture among adults 

aged 40 and over were 0.5% and 5.3%, 

respectively, compared with 0.9% and 

7.4%, respectively, among adults aged 

50 and over. In the age group 50 and 

over, approximately 19% had an elevated 

10-year hip fracture probability score, 

and 8% had an elevated 10-year major 

osteoporotic fracture probability score 

when intervention thresholds from NOF 

were applied (9). Subgroups for which 

the unadjusted prevalence of an elevated 

10-year probability of hip fracture was 

particularly notable included women 

(25%), non-Hispanic white persons 

(23%), and persons aged 70–79 (39%) 

and 80 and over (72%). 

Finding that fracture probability 

scores vary by age, sex, and race and 

Hispanic origin is not surprising, given 

that fracture incidence is known to vary 

by these factors. Furthermore, these 

characteristics are incorporated in the 

FRAX algorithm, either by inclusion as 

variables in the model or via development 

of separate race- and ethnicity-specific 

models that incorporated racial and ethnic 

differences in fracture occurrence in the 

United States. The current report adds to 

the knowledge base about risk by defining 

the actual magnitude of the 10-year 

fracture probability in these demographic 

groups, which has not been previously 

described for the U.S. population. 

This report also describes the 

prevalence of the different clinical 

risk factors (e.g., factors related to 

lifestyle and health history) that were 

used in calculating the 10-year fracture 

probability scores. The majority of 

middle-aged and older adults (59%) 

had at least one clinical risk factor for 

fracture in the survey period 2013–2014, 

and 23% had two or more risk factors. 

Three individual clinical risk factors 

(previous fracture, alcohol use, and 

current smoking) were fairly common, 

having been reported by 18%–35% 

of middle-aged and older adults. In 

contrast, the other individual clinical risk 

factors (parental hip fracture, RA, and 

glucocorticoid use) were reported by 9% 

or less of these adults. 
National Health Statistics Reports  Number 103  March 28, 2017 Page 7 

Figure 1. Prevalence of osteoporosis or low bone mass at the femur neck among adults 

aged 50 and over having elevated FRAX-based 10-year probability of hip or major 

osteoporotic fracture: United States, 2013 and 2014 

1

Defined as femur neck bone mineral density (BMD) T score of –2.5 or less. 2

Defined as femur neck BMD T score between –1.00 and –2.49. 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 

years. It is based on age, sex, race and Hispanic origin, femur neck BMD, body mass index, smoking, alcohol use, 

glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2013–2014. 

 

Osteoporosis1 

 

Low bone mass2 

 

Probability of fracture relative to threshold1: 

Major osteoporotic, above; hip, below Probability above thresholds1
 

for both fractures
 Less than 1% 

Probability of fracture relative 

to threshold1

: Hip, above; 

major osteoporotic, below 

Probability below 


thresholds for
 

both fractures1
 

 

1

Thresholds for 10-year fracture probabilities are: hip fracture, 3% or more; and major osteoporotic fracture, 20% or more.
 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 


years. It is based on age, sex, race and Hispanic origin, femur neck bone mineral density, body mass index, smoking, 


alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis.
 

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2013–2014.
 

Figure 2. Concordance of hip and major osteoporotic 10-year fracture probability status for 

adults aged 50 and over: United States, 2013 and 2014 

The thresholds to define elevated medications (9). Note that the NOF 

FRAX scores used in the present study guidelines use elevated FRAX scores 

were based on those used in NOF in combination with low bone mass to 

guidelines to identify persons who are define treatment eligibility, rather than 

candidates for treatment with bone-active focusing on FRAX scores alone. As a 

result, it was of interest in the present 

study to examine how many adults with 

elevated FRAX scores also had low 

bone mass. An estimated 95%–97% 

of those with an elevated hip or major 

osteoporotic fracture probability score 

had either low bone mass at the femur 

neck (fulfilling the NOF criteria for 

elevated fracture probability and low 

bone mass) or osteoporosis at the femur 

neck (fulfilling a separate criteria used in 

the NOF guidelines to identify treatmenteligible persons). The remaining 3%–5% 

with elevated fracture probability scores 

and normal femur neck status may have 

met one of the other conditions outlined 

in the NOF criteria (e.g., poor lumbar 

spine status or a previous hip or spine 

fracture), but this was not examined in 

the present study. It was also of interest 

to examine agreement in elevated 

probability of hip compared with major 

osteoporotic fracture risk as defined 

by the NOF cutoffs. The vast majority 

of adults aged 50 and over had similar 

status (89%), either elevated or not 

elevated, for both fracture probability 

estimates. Almost all of the adults 

with discordant status had an elevated 

hip fracture probability alone. Further 

analyses revealed that the majority 

of these persons also had a major 

osteoporotic fracture probability score 

that was within five percentage points of 

the threshold of 20%, indicating that the 

discordance was not extreme. However, 

some of the discordance may reflect 

the fact that the relationship between 

FRAX-based estimates of the 10-year 

probability of hip and major fractures is 

not straightforward, as noted by Kanis 

et al. (5). Specifically, Kanis et al. found 

that although the predicted probability of 

hip and major osteoporotic fractures were 

correlated, the magnitude of the predicted 

probability of a major osteoporotic 

fracture derived from the hip fracture 

probability estimate ranged between 5% 

and 25% (5). 

Note that definitions of elevated 

fracture probability used in osteoporosis 

guidelines may vary between countries 

as well as between guidelines within 

a country (5). Differences between 

countries may be related to differences 

in economic circumstances (e.g., 

reimbursement issues, access to health 

care, and others), while differences 
Page 8	 National Health Statistics Reports  Number 103  March 28, 2017 

between guidelines within a country may 

be related to the guideline objectives. For 

example, NOF thresholds were derived 

to serve as treatment thresholds (9), 

whereas the thresholds recommended 

by the U.S. Preventive Services Task 

Force were derived to identify those aged 

50–65 who should receive bone density 

testing (12). The present study used the 

thresholds recommended in the NOF 

guideline, since this guideline has been 

widely adopted within the United States 

and has also been cited as the basis for 

thresholds used in other countries (5). 

The NOF thresholds were based on a 

cost-effectiveness analysis conducted in 

the mid-2000s (20). However, concerns 

about the NOF thresholds have been 

noted, including the likelihood that many 

of the assumptions used in the costeffective analysis are now out-of-date, 

as well as questions of whether the hip 

fracture threshold is truly cost-effective 

(5). The assumption underlying the NOF 

threshold for major osteoporotic fracture 

(e.g., that major osteoporotic fracture 

risk greater than 20% is equivalent to 

the hip fracture risk greater than 3%) 

has also been questioned in light of the 

complicated relationship between fracture 

probabilities for these two fracture 

groups (5). 

Limitations of the present study 

include the use of self-reported clinical 

risk factor information to calculate the 

10-year fracture probability scores, 

because self-reported information can 

vary in accuracy. For example, a study 

using data from the Women’s Health 

Initiative found that the accuracy of 

self-reported fracture information varied 

depending on the skeletal site: Agreement 

between fractures identified via medical 

records compared with self-report was 

almost 80% for hip fracture and wrist or 

forearm fractures, but only 51% for spine 

fracture (22). The accuracy of reporting 

an RA diagnosis also appears to vary 

between self-report and medical records. 

In the present study, the prevalence of 

self-reported physician’s diagnosis of RA 

among adults aged 40 and over was 4.6%, 

but estimates of its prevalence among 

adults aged 18 and over is 0.5%–1% 

when based on medical records (23,24). 

Some of the discrepancy for RA may be 

caused by the difference in the age range 

considered because the incidence of RA 

increases with age (24), but it seems 

unlikely that this would account for the 

almost fivefold higher prevalence when 

based on self-report. On the other hand, 

use of self-reported data for the clinical 

risk factors used to calculate the fracture 

probability scores may correspond more 

closely to the way that this risk factor 

information is obtained in many clinical 

settings. For example, FRAX probability 

scores generated as part of a DXA 

examination at an imaging center may 

rely on self-reported information because 

the person’s medical records are not 

accessible in that setting. 

Other study limitations include 

possible nonresponse bias in the 

estimates, because 16% of examined 

respondents did not have 10-year fracture 

probability score data. Adjusting the 

sample weights for missing data by age, 

sex, and race and Hispanic origin in the 

analytic sample produced similar results 

as those based on the publicly available 

sample weights, which suggests that 

nonresponse bias in these demographic 

variables was not likely affecting 

results. These analyses do not address 

nonresponse bias due to other factors, 

however. Finally, institutionalized people, 

an important high-risk group for fracture, 

are not included in the NHANES 

sampling frame by design. 

In summary, this report provides the 

first nationally representative estimates 

of the absolute probability of suffering a 

hip or major osteoporotic fracture in the 

next 10 years among middle-aged and 

older adults in the United States using 

the FRAX model. These FRAX-based 

findings expand the understanding of 

skeletal health in the United States by 

providing a more global evaluation of 

fracture risk than can be obtained from 

estimates based on BMD alone (4). 

References 

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Gabriel S, Hirsch R, Kwoh CK, et al. 

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Page 10 National Health Statistics Reports  Number 103  March 28, 2017 

Table 1. FRAX-based 10-year probability of hip fracture among adults aged 40 and over, by sex, race and Hispanic origin, and age: 

United States, 2013 and 2014 

Back- Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard transformed 

and age group (years) size mean error mean1 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Both sexes Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 3,127 1.43 0.08 0.52 * 0.01 0.03 0.09 0.39 1.41 2.65 3.76 6.05 

40 and over, age-adjusted . . . . . . 3,127 1.53 ... 0.52 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 2,230 1.97 0.10 0.92 0.02 0.06 0.11 0.24 0.75 2.22 3.56 5.01 7.62 

50 and over, age-adjusted . . . . . . 2,230 2.26 ... 1.07 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 897 0.22 0.02 0.09 † **0.00 0.00 0.01 0.07 0.21 0.40 0.54 0.87 

50–59. . . . . . . . . . . . . . . . . . . . . . 784 0.91 0.10 0.38 0.01 0.02 0.04 0.09 0.29 0.77 1.50 1.99 3.56 

60–69. . . . . . . . . . . . . . . . . . . . . . 788 1.38 0.07 0.88 0.07 0.14 0.23 0.37 0.79 1.65 2.54 3.25 4.70 

70–79. . . . . . . . . . . . . . . . . . . . . . 428 3.83 0.38 2.53 0.34 0.54 0.71 1.13 2.32 4.47 6.48 8.84 12.34 

80 and over . . . . . . . . . . . . . . . . . 230 5.9 0.28 4.72 1.18 1.67 1.98 2.73 4.34 7.26 8.74 10.82 14.53 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 1,374 1.78 0.11 0.75 **0.01 0.04 0.07 0.16 0.58 1.91 3.32 4.52 7.33 

40 and over, age-adjusted . . . . . . 1,374 1.73 ... 0.68 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,029 2.31 0.14 1.18 0.04 0.11 0.17 0.35 0.99 2.75 4.16 5.73 8.77 

50 and over, age-adjusted . . . . . . 1,029 2.53 ... 1.30 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 345 0.29 0.03 0.14 * **0.00 **0.01 0.04 0.12 0.31 0.52 0.67 1.03 

50–59. . . . . . . . . . . . . . . . . . . . . . 337 1.11 0.14 0.50 0.02 0.04 0.07 0.14 0.39 1.00 1.85 2.82 3.80 

60–69. . . . . . . . . . . . . . . . . . . . . . 278 1.59 0.10 1.08 0.13 0.27 0.32 0.45 0.94 1.85 2.94 3.49 5.02 

70–79. . . . . . . . . . . . . . . . . . . . . . 235 4.32 0.52 2.99 0.48 0.72 0.91 1.40 2.57 5.20 7.00 9.22 13.95 

80 and over . . . . . . . . . . . . . . . . . 179 **6.20 0.32 **5.05 **1.48 **1.89 **2.17 **3.01 **4.90 **7.43 **8.77 **11.68 **15.12 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 626 0.36 0.04 0.09 † † † **0.01 0.06 0.25 0.55 0.90 1.46 

40 and over, age-adjusted . . . . . . 626 0.48 ... 0.11 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 464 0.52 0.07 0.20 * 0.01 0.01 0.04 0.12 0.49 0.90 1.20 1.99 

50 and over, age-adjusted . . . . . . 464 0.72 ... 0.28 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 693 0.51 0.04 0.17 † * **0.01 0.02 0.11 0.41 0.83 1.21 2.33 

40 and over, age-adjusted . . . . . . 693 0.92 ... 0.29 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 461 0.86 0.08 0.41 **0.01 **0.03 0.06 0.10 0.32 0.92 1.63 2.20 3.09 

50 and over, age-adjusted . . . . . . 461 1.37 ... 0.63 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 365 0.88 0.11 0.35 * **0.01 **0.02 0.06 0.25 0.92 1.60 2.23 3.77 

40 and over, age-adjusted . . . . . . 365 1.05 ... 0.42 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 238 1.35 0.16 0.76 0.05 0.09 0.13 0.24 0.65 1.52 2.53 3.22 4.56 

50 and over, age-adjusted . . . . . . 238 1.56 ... 0.87 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 69 **1.17 0.27 **0.41 * * * **0.06 **0.28 **1.27 * **2.65 **5.61 

40 and over, age-adjusted . . . . . . 69 **1.98 ... **0.71 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 38 **2.06 0.45 **1.14 * * **0.22 * **1.12 * **5.32 **5.59 **6.20 

50 and over, age-adjusted . . . . . . 38 **2.96 ... **1.60 ... ... ... ... ... ... ... ... ... 

See footnotes at end of table. 
 

National Health Statistics Reports  Number 103  March 28, 2017 Page 11 

Table 1. FRAX-based 10-year probability of hip fracture among adults aged 40 and over, by sex, race and Hispanic origin, and age: 

United States, 2013 and 2014—Con. 

Back- Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard transformed 

and age group (years) size mean error mean1 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Men Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 1,546 1.01 0.04 0.42 * 0.02 0.04 0.08 0.34 1.11 2.05 2.84 4.33 

40 and over, age-adjusted . . . . . . 1,546 1.12 ... 0.45 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,111 1.36 0.05 0.70 0.03 0.06 0.09 0.17 0.58 1.67 2.76 3.53 5.33 

50 and over, age-adjusted . . . . . . 1,111 1.59 ... 0.85 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 435 0.26 0.04 0.10 † **0.003 **0.01 0.02 0.10 0.24 0.43 0.55 0.94 

50–59. . . . . . . . . . . . . . . . . . . . . . 402 0.75 0.07 0.34 * 0.03 0.05 0.09 0.27 0.70 1.37 2.04 3.27 

60–69. . . . . . . . . . . . . . . . . . . . . . 384 1.1 0.10 0.70 0.06 0.12 0.21 0.31 0.66 1.22 1.78 2.26 3.41 

70–79. . . . . . . . . . . . . . . . . . . . . . 215 2.64 0.17 1.88 **0.18 0.41 0.50 0.90 1.82 3.42 4.54 5.68 6.90 

80 and over . . . . . . . . . . . . . . . . . 110 3.67 0.21 3.24 1.13 1.44 1.65 1.97 3.15 5.14 6.04 6.24 7.26 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 660 1.24 0.05 0.60 **0.02 0.04 0.07 0.14 0.49 1.53 2.52 3.41 5.18 

40 and over, age-adjusted . . . . . . 660 1.27 ... 0.59 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 495 1.58 0.06 0.90 0.04 0.09 0.15 0.29 0.77 2.10 3.09 4.01 5.88 

50 and over, age-adjusted . . . . . . 495 1.78 ... 1.03 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 165 0.34 0.06 0.16 * * **0.028 0.05 0.14 0.33 0.53 0.69 1.19 

50–59. . . . . . . . . . . . . . . . . . . . . . 175 0.91 0.07 0.45 **0.03 0.05 0.07 0.13 0.35 1.00 1.73 2.38 3.72 

60–69. . . . . . . . . . . . . . . . . . . . . . 123 1.27 0.12 0.86 * 0.25 0.29 0.42 0.76 1.38 2.04 2.42 3.48 

70–79. . . . . . . . . . . . . . . . . . . . . . 111 **2.89 0.21 **2.19 **0.37 **0.49 **0.71 **1.15 **2.29 **3.58 **4.77 **5.87 **7.36 

80 and over . . . . . . . . . . . . . . . . . 86 **3.87 0.23 **3.45 **1.21 **1.54 **1.71 **2.11 **3.33 **5.23 **6.08 **6.32 **7.34 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 329 0.28 0.05 0.08 † † † 0.01 0.07 0.24 0.47 0.58 1.02 

40 and over, age-adjusted . . . . . . 329 0.36 ... 0.10 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 250 0.38 0.08 0.15 † **0.00 **0.01 0.04 0.11 0.35 0.55 0.81 1.36 

50 and over, age-adjusted . . . . . . 250 0.51 ... 0.22 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 344 0.41 0.04 0.15 † 0.01 0.01 0.03 0.11 0.34 0.58 0.91 1.33 

40 and over, age-adjusted . . . . . . 344 0.78 ... 0.26 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 233 0.67 0.08 0.30 **0.01 **0.02 0.05 0.08 0.24 0.62 1.04 1.25 2.74 

50 and over, age-adjusted . . . . . . 233 1.16 ... 0.51 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 181 0.55 0.07 0.28 * 0.02 0.03 0.07 0.21 0.66 1.12 1.53 2.20 

40 and over, age-adjusted . . . . . . 181 0.67 ... 0.33 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 116 0.81 0.09 0.54 0.06 0.09 0.12 0.17 0.51 1.04 1.52 1.83 2.78 

50 and over, age-adjusted . . . . . . 116 0.94 ... 0.62 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 32 **1.02 0.34 **0.34 † * * * * * * **2.90 †

40 and over, age-adjusted . . . . . . 32 **0.97 ... **0.39 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 17 **1.87 0.62 **1.01 † † † † * * **5.40 † †

50 and over, age-adjusted . . . . . . 17 **1.42 ... **0.78 ... ... ... ... ... ... ... ... ... 

See footnotes at end of table. 
 

Page 12 National Health Statistics Reports  Number 103  March 28, 2017 

Table 1. FRAX-based 10-year probability of hip fracture among adults aged 40 and over, by sex, race and Hispanic origin, and age: 

United States, 2013 and 2014—Con. 

Back- Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard transformed 

and age group (years) size mean error mean1 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Women Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 1,581 1.84 0.15 0.62 * 0.01 0.02 0.09 0.46 1.78 3.32 4.94 8.66 

40 and over, age-adjusted . . . . . . 1,581 1.87 ... 0.58 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,119 2.55 0.18 1.18 0.02 0.08 0.13 0.3 0.97 2.96 4.69 6.57 9.78 

50 and over, age-adjusted . . . . . . 1,119 2.81 ... 01.3 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 462 0.19 0.02 0.07 † † **0.01 0.01 0.06 0.19 0.35 0.53 0.78 

50–59. . . . . . . . . . . . . . . . . . . . . . 382 1.1 0.21 0.43 **0.01 0.02 0.04 0.11 0.34 0.92 1.61 1.94 **3.66 

60–69. . . . . . . . . . . . . . . . . . . . . . 404 1.65 0.12 1.07 0.10 0.18 0.26 0.42 0.98 1.99 3.08 4.08 5.39 

70–79. . . . . . . . . . . . . . . . . . . . . . 213 4.92 0.63 3.26 0.58 0.73 0.89 1.37 2.63 5.84 8.87 11.39 17.63 

80 and over . . . . . . . . . . . . . . . . . 120 7.34 0.50 5.90 1.42 2.16 2.77 3.38 5.58 8.69 11.29 13.63 16.34 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 714 2.31 0.21 0.92 **0.01 0.03 0.07 0.17 0.72 2.57 4.28 5.99 9.39 

40 and over, age-adjusted . . . . . . 714 2.13 ... 0.76 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 534 3.02 0.24 1.52 **0.04 0.14 0.23 0.42 1.25 3.48 5.50 7.60 12.27 

50 and over, age-adjusted . . . . . . 534 3.17 ... 1.58 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 180 0.26 0.03 0.13 † * **0.01 **0.03 0.12 0.28 0.53 0.67 1.03 

50–59. . . . . . . . . . . . . . . . . . . . . . 162 1.35 0.31 0.56 0.02 * **0.08 0.15 0.43 1.07 1.91 3.14 *

60–69. . . . . . . . . . . . . . . . . . . . . . 155 1.9 0.17 1.32 0.18 0.31 0.38 0.63 1.20 2.58 3.39 4.57 5.39 

70–79. . . . . . . . . . . . . . . . . . . . . . 124 5.62 0.82 3.88 0.66 0.87 1.14 1.72 3.04 6.82 9.28 12.49 18.86 

80 and over . . . . . . . . . . . . . . . . . 93 **7.73 0.60 **6.35 **1.95 **2.72 **3.05 **3.71 **5.96 **8.73 **12.36 **13.99 **16.40 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 297 0.44 0.08 0.10 † † † 0.01 0.06 0.29 0.71 1.13 1.88 

40 and over, age-adjusted . . . . . . 297 0.56 ... 0.12 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 214 0.65 0.12 0.24 0.01 0.01 0.02 0.04 0.15 0.63 1.15 1.45 2.33 

50 and over, age-adjusted . . . . . . 214 0.86 ... 0.33 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 349 0.62 0.06 0.19 † * * **0.02 0.13 0.58 1.05 1.77 2.68 

40 and over, age-adjusted . . . . . . 349 1.04 ... 0.32 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 228 1.05 0.12 0.54 **0.02 **0.04 0.08 0.13 0.44 1.30 2.03 2.35 3.43 

50 and over, age-adjusted . . . . . . 228 1.55 ... 0.76 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 184 1.18 0.20 0.44 **0.01 0.02 **0.02 0.06 0.30 1.27 2.02 3.26 4.71 

40 and over, age-adjusted . . . . . . 184 1.35 ... 0.49 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 122 **1.79 0.27 **0.98 **0.04 **0.10 **0.15 **0.30 **0.83 **1.98 **3.27 **4.24 **5.83 

50 and over, age-adjusted . . . . . . 122 **2.04 ... **1.11 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 37 **1.33 0.42 **0.49 * * **0.05 **0.09 * **1.56 **1.59 * **5.02 

40 and over, age-adjusted . . . . . . 37 **1.86 ... **0.73 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 21 **2.24 0.67 **1.27 † * * * **1.24 **1.59 * **4.49 †

50 and over, age-adjusted 21 **2.79 ... **1.62 ... ... ... ... ... ... ... ... ... 

* Figure does not meet standards of reliability or precision; relative standard error (standard error / estimate) is 50% or more.
 

... Category not applicable.
 

†

 Standard error not calculated by SUDAAN.
 

** Figure does not meet standards of reliability or precision; relative standard error (standard error / estimate) is 30%–49% or estimate is based on less than 12 degrees of freedom.
 1

Calculated as (transformed mean)4.
 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 years. It is based on age, sex, race and Hispanic origin, femur neck bone mineral density, body mass index, smoking, alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. 
 

National Health Statistics Reports  Number 103  March 28, 2017 Page 13 

Table 2. FRAX-based 10-year probability of major osteoporotic fracture among adults aged 40 and over, by sex, race and Hispanic origin, 

and age: United States, 2013 and 2014 

Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard Geometric 

and age group (years) size mean error Mean 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Both sexes Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 3,127 7.45 0.21 5.26 1.22 1.76 2.08 2.71 5.31 9.70 13.28 15.71 20.80 

40 and over, age-adjusted . . . . . . 3,127 7.40 ... 5.09 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 2,230 9.47 0.21 7.41 2.21 2.96 3.59 4.49 7.36 12.51 15.45 18.51 23.87 

50 and over, age-adjusted . . . . . . 2,230 9.92 ... 7.72 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 897 2.87 0.09 2.41 0.93 1.06 1.19 1.68 2.35 3.54 4.42 5.19 6.32 

50–59. . . . . . . . . . . . . . . . . . . . . . 784 6.97 0.32 5.53 1.84 2.33 2.90 3.64 5.36 8.28 11.70 12.95 17.04 

60–69. . . . . . . . . . . . . . . . . . . . . . 788 9.49 0.30 7.95 2.61 3.52 4.20 5.30 8.14 12.77 15.19 17.28 21.07 

70–79. . . . . . . . . . . . . . . . . . . . . . 428 12.5 0.58 10.17 3.01 4.09 5.42 6.58 10.36 15.80 20.24 23.41 27.65 

80 and over . . . . . . . . . . . . . . . . . 230 16.1 0.52 13.45 5.02 5.74 6.39 9.01 13.96 20.63 25.47 28.50 34.79 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 1,374 8.99 0.23 6.94 2.19 2.57 3.11 4.11 6.82 11.96 15.15 17.81 22.97 

40 and over, age-adjusted . . . . . . 1,374 8.49 ... 6.38 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,029 10.91 0.22 9.09 3.74 4.23 4.66 5.78 8.56 13.80 17.23 20.43 24.66 

50 and over, age-adjusted . . . . . . 1,029 11.20 ... 9.28 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 345 3.62 0.08 3.25 1.80 1.92 2.09 2.26 2.98 4.20 5.19 5.96 7.65 

50–59. . . . . . . . . . . . . . . . . . . . . . 337 8.19 0.40 6.90 3.30 3.73 4.05 4.45 6.27 9.98 12.36 13.95 17.91 

60–69. . . . . . . . . . . . . . . . . . . . . . 278 10.97 0.31 9.77 4.55 5.16 5.62 7.18 9.11 13.99 16.58 18.71 21.91 

70–79. . . . . . . . . . . . . . . . . . . . . . 235 13.99 0.75 11.91 4.46 5.79 6.27 8.04 11.70 17.30 22.19 24.4 28.40 

80 and over . . . . . . . . . . . . . . . . . 179 *16.86 0.55 *14.39 *5.33 *6.32 *7.12 *9.73 *14.62 *22.15 *26.47 *30.11 *36.18 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 626 2.71 0.11 2.13 0.80 0.90 1.03 1.31 2.01 3.11 4.24 5.46 6.74 

40 and over, age-adjusted . . . . . . 626 2.94 ... 2.22 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 464 3.44 0.15 2.87 1.34 1.53 1.66 1.86 2.61 3.96 5.51 6.30 7.64 

50 and over, age-adjusted . . . . . . 464 3.86 ... 3.12 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 693 3.52 0.11 2.66 1.00 1.07 1.15 1.50 2.45 4.24 5.81 7.52 9.59 

40 and over, age-adjusted . . . . . . 693 4.52 ... 3.23 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 461 5.11 0.16 4.23 1.97 2.14 2.28 2.64 3.89 6.27 7.91 9.20 12.02 

50 and over, age-adjusted . . . . . . 461 6.08 ... 4.84 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 365 4.32 0.26 3.11 1.04 1.15 1.27 1.60 2.97 5.36 6.98 8.39 12.12 

40 and over, age-adjusted . . . . . . 365 4.68 ... 3.31 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 238 6.03 0.32 4.93 2.12 2.42 2.61 3.12 4.47 6.94 9.10 11.51 15.26 

50 and over, age-adjusted . . . . . . 238 6.41 ... 5.16 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 69 *6.63 0.79 *4.70 *1.44 *1.74 *1.77 *2.13 *4.18 *9.31 *12.52 *14.60 *15.47 

40 and over, age-adjusted . . . . . . 69 *8.83 ... *6.06 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 38 *10.23 1.01 *8.77 *3.54 *3.92 *4.13 *6.13 *9.04 *12.86 *14.78 *15.28 *17.33 

50 and over, age-adjusted . . . . . . 38 *12.18 ... *10.09 ... ... ... ... ... ... ... ... ... 

See footnotes at end of table. 
 

Page 14 National Health Statistics Reports  Number 103  March 28, 2017 

Table 2. FRAX-based 10-year probability of major osteoporotic fracture among adults aged 40 and over, by sex, race and Hispanic origin, 

and age: United States, 2013 and 2014—Con. 

Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard Geometric 

and age group (years) size mean error Mean 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Men Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 1,546 5.57 0.16 4.31 1.18 1.66 1.93 2.52 4.41 7.41 9.65 11.14 13.55 

40 and over, age-adjusted . . . . . . 1,546 5.55 ... 4.25 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,111 6.85 0.17 5.71 1.86 2.46 2.99 3.93 5.72 8.73 11.09 12.52 15.02 

50 and over, age-adjusted . . . . . . 1,111 7.10 ... 5.93 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 435 2.76 0.14 2.33 0.89 1.04 1.18 1.67 2.32 3.34 4.19 4.88 5.76 

50–59. . . . . . . . . . . . . . . . . . . . . . 402 5.69 0.23 4.70 1.64 2.06 2.47 3.25 4.43 6.83 8.84 10.86 12.96 

60–69. . . . . . . . . . . . . . . . . . . . . . 384 7.23 0.31 6.20 2.21 2.72 3.37 4.48 6.35 8.94 10.89 12.02 14.15 

70–79. . . . . . . . . . . . . . . . . . . . . . 215 8.41 0.38 7.15 2.31 3.11 3.72 5.25 7.40 11.01 13.40 14.84 18.21 

80 and over . . . . . . . . . . . . . . . . . 110 9.23 0.36 8.38 4.34 4.79 5.23 5.86 8.36 11.53 13.92 14.65 16.08 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 660 6.68 0.14 5.61 2.09 2.46 2.95 3.75 5.49 8.53 10.67 12.27 14.66 

40 and over, age-adjusted . . . . . . 660 6.41 ... 5.30 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 495 7.89 0.14 6.99 3.33 3.93 4.14 4.67 6.82 9.74 11.70 13.30 15.67 

50 and over, age-adjusted . . . . . . 495 8.05 ... 7.14 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 165 3.45 0.17 3.11 1.77 1.86 2.00 2.23 2.76 4.14 4.88 5.34 †

50–59. . . . . . . . . . . . . . . . . . . . . . 175 6.68 0.22 5.86 3.05 3.35 3.66 4.13 5.14 8.14 10.48 12.06 14.16 

60–69. . . . . . . . . . . . . . . . . . . . . . 123 8.40 0.36 7.66 4.06 4.52 4.77 5.47 8.07 9.76 11.33 12.89 15.06 

70–79. . . . . . . . . . . . . . . . . . . . . . 111 *9.29 0.37 *8.33 *3.63 *4.45 *5.27 *6.09 *8.16 *11.26 *13.98 *15.29 *19.51 

80 and over . . . . . . . . . . . . . . . . . 86 *9.71 0.39 *8.97 *4.82 *5.24 *5.45 *6.35 *9.11 *11.93 *14.48 *14.68 *16.35 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 329 2.07 0.07 1.77 0.79 0.86 0.95 1.25 1.72 2.47 2.95 3.34 4.06 

40 and over, age-adjusted . . . . . . 329 2.15 ... 1.82 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 250 2.46 0.10 2.19 1.25 1.33 1.44 1.60 2.01 2.85 3.26 3.69 4.94 

50 and over, age-adjusted . . . . . . 250 2.62 ... 2.33 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 344 2.78 0.11 2.29 0.94 1.04 1.13 1.43 2.28 3.21 4.27 5.13 6.30 

40 and over, age-adjusted . . . . . . 344 3.39 ... 2.70 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 233 3.76 0.12 3.31 1.67 2.00 2.10 2.34 2.99 4.59 5.51 6.01 7.56 

50 and over, age-adjusted . . . . . . 233 4.36 ... 3.73 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 181 3.04 0.19 2.48 1.00 1.10 1.23 1.47 2.43 3.97 4.61 5.75 7.02 

40 and over, age-adjusted . . . . . . 181 3.27 ... 2.66 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 116 4.09 0.25 3.66 1.88 2.14 2.32 2.60 3.53 4.59 5.86 6.90 8.29 

50 and over, age-adjusted . . . . . . 116 4.24 ... 3.77 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 32 *4.95 0.64 *3.85 † *1.74 *1.75 *2.05 *3.44 *6.68 *8.06 *10.60 *11.47 

40 and over, age-adjusted . . . . . . 32 *5.12 ... *4.12 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 17 *7.63 0.67 *6.83 † *3.71 *3.80 *4.01 *6.75 *9.68 *11.36 *11.48 *12.64 

50 and over, age-adjusted . . . . . . 17 *6.76 ... *5.97 ... ... ... ... ... ... ... ... ... 

See footnotes at end of table. 
 

National Health Statistics Reports  Number 103  March 28, 2017 Page 15 

Table 2. FRAX-based 10-year probability of major osteoporotic fracture among adults aged 40 and over, by sex, race and Hispanic origin, 

and age: United States, 2013 and 2014—Con. 

Percentile 

Sex, race and Hispanic origin, Sample Arithmetic Standard Geometric 

and age group (years) size mean error Mean 5th 10th 15th 25th 50th 75th 85th 90th 95th 

Women Percent 

All race and Hispanic origin: 

40 and over . . . . . . . . . . . . . . . . . 1,581 9.29 0.32 6.38 1.27 1.88 2.24 3.12 6.74 13.05 16.60 19.75 24.78 

40 and over, age-adjusted . . . . . . 1,581 9.01 ... 6.00 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 1,119 11.97 0.30 9.52 2.79 3.75 4.55 6.02 9.64 15.58 19.43 22.94 27.65 

50 and over, age-adjusted . . . . . . 1,119 12.35 ... 9.77 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 462 2.99 0.11 2.50 0.99 1.10 1.22 1.72 2.44 3.76 4.55 5.89 7.27 

50–59. . . . . . . . . . . . . . . . . . . . . . 382 8.39 0.52 6.62 2.13 2.72 3.30 4.27 6.33 10.31 12.98 15.27 19.08 

60–69. . . . . . . . . . . . . . . . . . . . . . 404 11.57 0.48 9.97 3.55 4.63 5.72 7.07 9.78 15.24 17.77 20.30 22.12 

70–79. . . . . . . . . . . . . . . . . . . . . . 213 16.20 0.92 13.97 5.66 6.92 8.00 9.62 14.56 20.38 24.41 27.65 †

80 and over . . . . . . . . . . . . . . . . . 120 20.54 0.84 18.23 6.55 10.24 12.23 13.39 18.06 25.19 30.09 33.63 39.41 

Non-Hispanic white: 

40 and over . . . . . . . . . . . . . . . . . 714 11.27 0.40 8.55 2.23 2.68 3.52 4.91 8.70 15.24 19.15 22.71 27.28 

40 and over, age-adjusted . . . . . . 714 10.35 ... 7.57 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 534 13.84 0.38 11.74 4.54 5.60 6.18 7.64 12.20 17.29 21.58 24.42 29.95 

50 and over, age-adjusted . . . . . . 534 13.99 ... 11.80 ... ... ... ... ... ... ... ... ... 

40–49. . . . . . . . . . . . . . . . . . . . . . 180 3.81 0.16 3.41 1.85 2.06 2.17 2.40 3.08 4.35 5.93 6.27 8.08 

50–59. . . . . . . . . . . . . . . . . . . . . . 162 9.88 0.72 8.28 3.89 4.40 4.76 5.58 7.31 12.05 14.19 17.22 †

60–69. . . . . . . . . . . . . . . . . . . . . . 155 13.40 0.46 12.29 6.77 7.25 7.63 8.43 12.9 16.58 19.08 21.32 22.85 

70–79. . . . . . . . . . . . . . . . . . . . . . 124 18.25 1.14 16.45 8.08 9.53 9.97 11.73 15.79 22.8 26.89 28.30 †

80 and over . . . . . . . . . . . . . . . . . 93 *21.53 0.99 *19.57 *9.96 *12.23 *12.99 *14.32 *19.24 *26.47 *30.49 *34.03 *39.41 

Non-Hispanic black: 

40 and over . . . . . . . . . . . . . . . . . 297 3.30 0.18 2.52 0.81 0.98 1.08 1.50 2.44 4.10 5.73 6.46 7.69 

40 and over, age-adjusted . . . . . . 297 3.56 ... 2.62 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 214 4.36 0.28 3.70 1.71 1.93 2.05 2.38 3.47 5.55 6.48 6.94 9.20 

50 and over, age-adjusted . . . . . . 214 4.80 ... 3.98 ... ... ... ... ... ... ... ... ... 

Hispanic: 

40 and over . . . . . . . . . . . . . . . . . 349 4.28 0.16 3.08 1.04 1.14 1.21 1.61 2.80 5.40 7.81 8.59 11.91 

40 and over, age-adjusted . . . . . . 349 5.46 ... 3.79 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 228 6.46 0.28 5.40 2.20 2.60 2.84 3.34 5.11 8.03 10.07 11.68 15.67 

50 and over, age-adjusted . . . . . . 228 7.50 ... 6.07 ... ... ... ... ... ... ... ... ... 

Non-Hispanic Asian: 

40 and over . . . . . . . . . . . . . . . . . 184 5.47 0.40 3.81 1.09 1.19 1.39 1.74 3.83 6.90 9.20 11.88 15.97 

40 and over, age-adjusted . . . . . . 184 5.83 ... 3.96 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 122 *7.63 0.45 *6.31 *2.52 *3.05 *3.17 *3.94 *6.13 *8.77 *11.90 *14.96 *17.75 

50 and over, age-adjusted . . . . . . 122 *8.14 ... *6.64 ... ... ... ... ... ... ... ... ... 

Other races, including multiracial: 

40 and over . . . . . . . . . . . . . . . . . 37 *8.45 1.14 *5.84 *1.10 *1.64 *1.87 *2.32 *7.16 *12.63 *14.62 *15.26 *17.41 

40 and over, age-adjusted . . . . . . 37 *9.63 ... *6.75 ... ... ... ... ... ... ... ... ... 

50 and over . . . . . . . . . . . . . . . . . 21 *12.61 1.32 *11.04 † *4.76 *5.24 *7.87 *12.14 *14.82 *15.93 *17.15 †

50 and over, age-adjusted . . . . . . 21 *13.23 ... *11.47 ... ... ... ... ... ... ... ... ... 

... Category not applicable. 

* Figure does not meet standards of reliability or precision; relative standard error (standard error / estimate) is 30%–49% or estimate is based on less than 12 degrees of freedom. 

†

 Standard error not calculated by SUDAAN. 

NOTES: FRAX-based 10-year fracture probability is an estimate of the likelihood of having a fracture during the next 10 years. It is based on age, sex, race and Hispanic origin, femur neck bone 

mineral density, body mass index, smoking, alcohol use, glucocorticoid use, personal and parental fracture history, and rheumatoid arthritis. 
National Health Statistics Reports  Number 103  March 28, 2017

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Suggested citation 

Looker AC, Sarafrazi Isfahani N, Fan B, 

Shepherd JA. FRAX-based estimates of 

10-year probability of hip and major 

osteoporotic fracture among adults aged 

40 and over: United States, 2013 and 2014. 

National health statistics reports; no 103. 

Hyattsville, MD: National Center for Health 

Statistics. 2017. 

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated. 

National Center for Health Statistics 

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate Director 

for Science 

Division of Health and Nutrition 


Examination Surveys
 

Kathryn S. Porter, M.D., M.S., Director 

Ryne Paulose-Ram, Ph.D., Associate Director 

for Science