Signed and returned questionnaires were considered as informed consent to be included in the analysis.

All participants were anonymized and the study was approved by the Local Ethical Committee. The questionnaire was designed to enable calculation of fracture risk based on each tool at an individual level. It therefore comprised items on weight, selleck products height, ethnicity, history of osteoporosis, personal and family history of fracture, smoking habits, consumption of alcohol, use of oral glucocorticoids, use of oestrogen, and diseases associated with secondary osteoporosis (e.g. rheumatoid arthritis, type 1 diabetes, osteogenesis imperfecta, untreated long-standing www.selleckchem.com/products/pifithrin-alpha.html hyperthyroidism, hypogonadism or premature menopause (< 45 years), chronic malnutrition, or malabsorption and chronic liver disease). The questions were constructed to allow answering by simple “yes”, “no” or “don't know”, however, body height and weight could be entered as digits. The questionnaire was validated and the reliability

tested as previously reported [24]. The questionnaire was read by optical character recognition (OCR); the accuracy of this setup was previously tested without any difference in data registration [24]. Self-reported baseline data were used to calculate the 10-year probability of fracture by FRAX® and to calculate the risk estimate using the simpler tools, ORAI, OSIRIS, OST and SCORE in each woman. Further, age alone was used in the analysis, where the age of the women is used as a simple continuous variable. The number of risk factors used in each tool varies from two in OST to 10 in FRAX®. Table 1 shows the clinical risk factors included in each tool. Since the detailed algorithm for FRAX® is still not in the public domain, the 10-year probability of fracture was calculated by individual risk scoring using the Danish version of FRAX® [25] using a call of

the FRAX® website (version 3.4) [26]. ORAI, OSIRIS, OST and SCORE are instruments designed to predict low BMD. The scoring system for ORAI [15] is as Adenosine follows: + 2 points for non-current usage of estrogen; + 9 points for a body weight of less than 60 kg or + 3 points for a body weight between 60 and 70 kg and 0 points for weight above 70 kg; and + 15 points for ages 75 years or more, + 9 points for ages between 65 and 74 years, + 5 points for ages between 55 and 64, and 0 points for ages between 45 and 54. To calculate the OST score [14], age was subtracted from weight, the result multiplied by 0.2 and truncated to yield an integer. The OSIRIS score [16] was calculated by adding the index value weighted for each variable: weight (kg) × 2 and remove last digit; age (year) × − 2 and remove last digit; + 2 if a current HRT user, and − 2 if the women have a history of low impact fracture.