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The commonly used U.S version of the Fracture Risk Assessment Tool (FRAX) should not be routinely used to select younger postmenopausal women for bone mineral density testing. FRAX includes self-identified race and ethnicity information, and the Osteoporosis Self-Assessment Tool (OST) does not, but both had suboptimal performance in determining major osteoporotic fracture risk across racial/ethnic categories in younger postmenopausal women. However, OST is excellent at identifying women with osteoporosis-level bone mineral density, which is the goal of these screenings, while FRAX is not. In addition, inclusion of racial/ethnic categories in clinical risk prediction tools is controversial and the subject of much debate.

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