What Is the Value of DXA in Predicting Fracture Risk in Postmenopausal Women? A 10-Year Follow-Up Study in the Małopolska Region

<b>Background:</b> Bone mineral density (BMD) assessed by DXA is a well-established predictor of osteoporotic fracture risk. However, data regarding the Polish female population remains limited. <b>Objective:</b> To evaluate the predictive value of BMD measurements for vertebral, hip, and all low-energy fractures in women aged 50 years and older. <b>Methods:</b> A total of 1.311 women from the Małopolska region underwent BMD assessment at the femoral neck, lumbar spine. The average follow-up period was 10.2 years, during which 479 osteoporotic fractures were recorded. <b>Results:</b> DXA measurements at the femoral neck showed the strongest correlation with hip fracture risk. Each one standard deviation decrease in the femoral neck T-score increased the risk of hip fracture by 2.1 times (HR 2.10; 95% CI 1.28-3.46; <i>p</i> = 0.003), after adjusting for age, but is not linear. A 1 SD decrease in the hip T-score was associated with a 28% increase in the risk of all osteoporotic fractures (HR 1.28; CI 1.17-1.40; <i>p</i> < 0.001), 53% increase in vertebral (HR 1.53; CI 1.13-2.08; <i>p</i> = 0.006) and 30% in hip (HR 1.30; CI 0.81-2.09; <i>p</i> = 0.278). The AUC values for hip BMD and hip T-score had the highest predictive value-AUC (area under the curve was 0.732 and 0.720, <i>p</i> < 0.01). <b>Conclusions:</b> BMD at the femoral neck proved to be a stronger predictor of hip fractures than measurements at the spine, radius. The risk increase associated with BMD/T-score reduction was non-linear. These findings confirm results from other benchmark studies.