The Canadian Task Force on Preventive Health Care (task force) recommends “risk assessment–first” screening to prevent fragility fractures in females aged ≥ 65 years, as follows (conditional recommendation; low-certainty evidence):

• Apply the Canadian clinical FRAX* (without BMD). Use the 10-year absolute risk of major osteoporotic fracture to facilitate shared decision-making about the possible benefits and harms of preventive pharmacotherapy.
• After discussion, if preventive pharmacotherapy is considered, request BMD measurement using DXA of the femoral neck. Then re-estimate fracture risk by adding the BMD T-score into FRAX.

We recommend against screening females aged 40–64 years and males aged ≥ 40 years to prevent fragility fractures (strong recommendation; very low-certainty evidence).