Introduction and objective:
It is estimated that 80% of patients with low-trauma fractures leave the hospital without diagnosis and treatment for osteoporosis. Over 20% of hip fracture patients die within a year, and 25% are left dependent. The primary aim of the study is to evaluate the outcomes of a coordinated primary care screening programme designed to identify postmenopausal women at increased risk of osteoporotic fractures. The second aim is to assess the practical usefulness of FRAX as a triage tool for referral to specialist evaluation.

Material and methods:
The records of 2,051 women aged 50–69 years without a prior diagnosis of osteoporosis or osteopenia were analyzed. After initial screening at primary care, the 10-year fracture risk was assessed using FRAX. Eligible patients were referred to a specialist centre, where further diagnostics were performed, and recommendations made to the family physician.

Results:
In Stage I, 59.1% of women had a moderate (5–10%) or high (>10%) 10-year fracture risk. A total of 1,126 patients were referred to Stage II, and 850 completed the evaluation. Osteoporosis was diagnosed in 41.8%, osteopenia in 39.4%, and normal results was found in only 17.8%. FRAX >10% was associated with a higher probability of osteoporosis than FRAX 5–10%, but the association was weak. The cumulative risk of bone mineral density deficiency was higher in the high-risk group. Diagnosing low-trauma fractures in primary care had low sensitivity (15.9%) and high specificity (93.4%).

Conclusions:
The programme revealed a high prevalence of unrecognized osteoporosis and osteopenia in postmenopausal women. FRAX is a useful screening tool in primary care, but it does not replace DEXA. The results show the need for better education of primary care physicians and coordination of care to reduce the treatment gap in osteoporosis.