FRAX® is a fracture risk assessment tool developed by WHO working groups. Ten-year risks for major osteoporotic fractures or hip fracture can be calculated with FRAX®. It has been discussed how to utilize FRAX® in the clinical settings in Japan. It was necessary to recognize the performance and limitation of this tool. In the Japanese guideline for prevention and treatment of osteoporosis 2011, a threshold of 10-year risk for major osteoporotic risk was proposed for the patients with osteopenia. It is emphasized that this is the proposal to use FRAX® in addition to the result of bone mineral density measurement and is not the proposal to use FRAX® as a screening tool. The way to utilize FRAX® as a screening tool should be investigated further.