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Background In Europe, a case-finding strategy for osteoporosis is recommended above widespread population-based screening. However, no universally accepted policy currently exists. In 2005, the Dutch College of General Practitioners published guidelines for GPs to select patients for dual energy X-ray absorptiometry (DXA). Aim To evaluate the sensitivity, specificity, and predictive value of the Dutch guidelines to select participants with osteoporosis for DXA. Design of study Cross-sectional. Setting A total of 345 females aged over 50 years (mean age = 62 years, standard deviation [SD] = 8.3) and 99 males over 65 years of age (mean age = 72 years, SD = 5.2) of a Dutch general practice. Method Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Dutch case-finding instrument for selecting patients with osteoporosis for DXA measurement. Results Sensitivity was 19.5%, specificity 85.6%, PPV 18.6%, and NPV 86.6%. Conclusion The Dutch guidelines are unreliable in detecting people at risk for osteoporosis. [ABSTRACT FROM AUTHOR]