Background: Bone mineral density (BMD), considered to be a gold standard for the diagnosis of osteoporosis, is most commonly measured by dual-energy x-ray absorptiometry (DXA). For patients with osteopenia, the Fracture Risk Assessment Tool (FRAX) incorporates acknowledged other risk factors to assess overall fracture risk and aids in patient management. If the FRAX score in an osteopenic patient predicts a 10-year fracture risk of >20% for a major osteoporotic fracture or >3% for a hip fracture, pharmacologic therapy is indicated. However, FRAX does not include an assessment of a significant decline in BMD over time.