This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

We do not know if fracture predicting factors are constant throughout life, if they can be assessed earlier in life, and for how long. The aim was to study the association between questions about health status and mobility and fragility fractures in a cohort during a 35-year follow-up. A cohort of 16,536 men and women in two age groups, 26–45 and 46–65 years old, who answered five questions of their physical health status in postal surveys in 1969–1970. We obtained data on hip fractures from 1970 to the end of 2016. We found most significant results when restricting the follow-up to age 60–85 years, 35 for the younger age group and 20 years for the older. Men of both age groups considered “at risk” according to their answers had a 2.69 (CI 1.85–3.90)– 3.30 (CI 1.51–7.23) increased risk of having a hip fracture during a follow-up. Women in the younger age group had a 2.69 (CI 1.85–3.90) increased risk, but there was no elevated risk for women in the older age group. This study shows that questions/index of physical health status may be associated with hip fractures that occur many years later in life, and that there is a time span when the predictive value of the questions can be used, before other, age-related, factors dominate. Our interpretation of the results is that we are studying the most vulnerable, who have hip fractures relatively early in life, and that hip fractures are so common among older women that the questions in the survey lose their predictive value.

Summary FRAX is a tool based on questions that identifies persons at risk of fragility fractures. We interviewed patients about their thoughts on doing FRAX in a dental setting. They were generally positive but had some concerns that need to be considered before introducing FRAX in a dental setting. Purpose To investigate patients’ thoughts about assessing the risk of fragility fractures using the FRAX tool in a dental setting. Sweden has a high incidence of fragility fractures, but many of these are preventable. The most common method for identifying persons with a high risk of sustaining fragility fractures is FRAX, a validated instrument for assessing the risk of suffering fragility fractures within 10 years. In the Nordic countries, most of the adult population has regular contact with their dentist, which could be useful in identifying high-risk individuals. Methods A qualitative inductive approach to content analysis, with individual semi-structured interviews, was used. Seven women and three men, aged 65–75 years, were interviewed and assessed with FRAX. Results An overarching theme was that patients considered a FRAX assessment in the dental setting a good service but doubted that the dentists would have the interest, time, and knowledge to do it. The patients had little knowledge and experience of osteoporosis and fragility fractures. They were positive towards assessing the fracture risk with the FRAX instrument. If they were found to have a high fracture risk, they expected the dentist to send a referral for further investigation and to collaborate in the risk assessment with their family physician. They thought risk assessment in a dental context would be a good service if the fee was the same as that in primary care. Conclusion Most participants were positive about having FRAX and other health assessments done in the dental clinic, but this study shows that patients have concerns that need to be addressed before introducing FRAX in this context.