Renal transplant patients have a high prevalence of osteopenia, osteoporosis and fractures. The aim of the study was to investigate whether dual-energy x-ray absorptiometry (DXA) is of value to predict fractures. In 1995-2007, 238 renal transplant patients underwent 670 DXA investigations. Osteopenia (46.0%), osteoporosis (13.9%) and absolute bone mineral density (BMD) (median 0.9, range 0.4-2.0 g/cm(2)) in the hip region were used to evaluate fracture risk. Data on fractures were collected at the occasion of each DXA, and a questionnaire was filled in by 191 patients at regular outpatient visits. Reported fractures were verified by consultation of medical records. In all, 46 patients had 53 fractures. Cumulative hazard of fracture was significantly different among normal BMD, osteopenia and osteoporosis in the hip (p < 0.0001). A Cox proportional hazard analysis also including age, gender and diabetic nephropathy showed significantly increased fracture risk for osteoporosis (3.5 times, CI 1.8-6.4, p = 0.0001) as well as for osteopenia (2.7 times, 1.6-4.6, p = 0.0003). A significantly increased risk was also found with absolute BMD estimates below the median. Osteopenia and an absolute bone density below 0.9 g/cm(2) in the hip region confer an increased risk of fracture.