Probability of fractures predicted by FRAX® and observed incidence in the Spanish ECOSAP Study cohort

► ECOSAP is a 3-year prospective study with fracture data from 5,201 Spanish women. ► FRAX® underestimated the risk of major osteoporotic fractures in the ECOSAP cohort. ► The estimated compared with the observed women with hip fractures were similar. ► Clinical judgment is needed to estimate the fracture risk in the individual patient.