Context and Objective: It is not known which factors are associated with fracture in non-osteoporotic elderly. The aim of this study was to assess the association between fall-related risk factors and fracture risk in men and women without osteoporosis.

Design: The study was part of the on-going Dubbo Osteoporosis Epidemiology Study, which was designed as a prospective population-based cohort investigation.

Participants: At baseline, 924 women and 723 men aged 60+ years did not have osteoporosis (BMD T-scores > -2.5). The individuals have been followed for up to 15yr.

Main outcome measures: Atraumatic fractures were prospectively identified through radiologists' reports.

Risk factors: Al baseline, femoral neck bone mineral density (FNBMD) was measured by DXA; history of fall, postural stability, and quadriceps strength were obtained.

Results: During the follow-up period, among the non-osteoporotic group, 221 women and 105 men had sustained a fracture, accounting for 55% and 74% of total fractures in the entire DOES sample, respectively. The following factors were independent risk factors for any fracture: in women, age per SD (HR: 1.2, 95% CI: 1.0-1.3), postural sway per SD (1.1, 1.0-1.2), FNBMD per SD (1.6, 1.3-1.9), fall in the previous 12 months (2.1, 1.6-2.7) and prior fracture (1.8, 1,2-2.7); in men, age (1.4, 1.1-1.6), postural sway (1.2, 1.0-1.3), FNBMD (1.2, 1.0-1.5), and fall in the previous 12 months (1.9, 1.2-3.0). Exposure to at least one of the risk factors could account for 49% (women) and 39% (men) of any fractures in this population.

Conclusion: In non-osteoporotic elderly, the combination of low BMD, advancing age, fall during the last 12 months, and prior fracture could identify a subgroup of individuals with high risk of fracture.