@njx58 I thought the study's message was that "low BMD has been recognized as the most robust risk factor for fragility fracture." But if the majority of fractures actually occur in those without osteoporotic BMD, then doctors should put greater focus on risk factors other than BMD.

One of the most significant factors that contribute to fractures in the elderly is a fall. The report says "A history of fall was associated with a fourfold increase in fracture risk. Thus, it can be estimated that ≤47% of hip fractures are attributable to fall. "

BMD is important, of course, but also important in fracture prevention is physical strength, balance, proper nutrition and protein levels etc. So, doctors should also encourage patients to keep physically active, do exercises that maintain or improve leg strength and balance.