van Welzen BJ, et al. - As per current guidelines, a Fracture Risk Assessment Tool (FRAX) score should be calculated in patients aged 40–49 years and dual-energy x-ray absorptiometry (DXA) should be performed on patients with a 10-year risk of a major osteoporotic fracture ≥ 10% to assess BMD, researchers here examined the sensitivity of this threshold to distinguish patients with risk of osteoporosis in this age category—as a surrogate marker for high fracture risk. They calculated a clinical risk factor–based FRAX score of patients aged 50–59 years and living with HIV for at least 10 years who recently underwent dual-energy x-ray absorptiometry (DXA) using patient characteristics from 10 years earlier. In the present cohort of 126 patients, 23 patients (18.3%) had osteoporosis. Ten years before the DXA, the guideline threshold of a 10-year major osteoporotic fracture probability of ≥ 10% was not met by any of the patients; this indicated a sensitivity of 0% in this cohort. Findings thereby suggest that FRAX is not sensitive to identify HIV-infected patients aged 40–49 years who should undergo BMD testing for reduced BMD. Hence they recommend limiting its role to treatment decisions.