Fracturen tengevolge van osteoporose kunnen ontstaan na een val, maar bij ernstige vormen van osteoporose kunnen ze ook spontaan of tengevolge van een klein trauma ontstaan. Een wervelfractuur is de meest specifieke uiting van osteoporose, omdat bij het ontstaan ervan de invloed van een val beperkt betekenis heeft. In de wervelkolom kunnen fracturen optreden tijdens routineactiviteiten, zoals buigen, zich oprichten of opstaan vanuit de stoel of bij het uit bed komen.

Het risico op het krijgen van een fractuur hangt nauw samen met de BMD, maar ook met het valrisico.^13,50 Alhoewel het risico op een fractuur toeneemt naarmate de BMD lager is, is deze relatie niet lineair. Verschillende prospectieve studies laten zien dat een daling van de BMD met 1 SD het risico op fracturen verhoogt met een factor 1,4-2,5.^51-54 Een verschil van 2 SD’s is geassocieerd met een 4-6-voudig toegenomen fractuurrisico; een eerder doorgemaakt wervelfractuur is geassocieerd met een 5 keer hoger risico op een nieuwe wervelfractuur.⁵⁵Andere risicofactoren voor fracturen zijn een verminderde spierkracht, balans en weinig fysieke activiteit.^56,57 
De volgende factoren verhogen het risico op heup- en wervelfracturen.

• leeftijd > 60 jaar;
• een fractuur na het 50^e levensjaar (of aanwezige wervelfractuur);
• familiegeschiedenis: moeder had een heupfractuur;
• laag lichaamsgewicht (< 60 kg);
• gebruik van corticosteroïden (> 7,5 mg/dag) langer dan 3 maanden;
• visusstoornissen;
• ernstige immobiliteit.

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