The assessment of fracture risk involves evaluating bone mineral density (BMD), clinical risk factors, and biochemical bone markers. BMD, measured by dual-energy X-ray absorptiometry (DXA), is the standard for diagnosing osteoporosis and assessing fracture risk, but it has limitations, such as not capturing bone geometry or microarchitecture. The Fracture Risk Assessment Tool (FRAX) uses clinical risk factors to predict fracture risk, which can be useful for patients with low BMD (T-score between -1.0 and -2.5) and a ten-year hip fracture risk of ≥3% or a ten-year major osteoporosis-related fracture risk of ≥20%. Biochemical bone markers, such as NTX, CTX, and bone-specific alkaline phosphatase, help monitor treatment efficacy and assess fracture risk. Bone turnover markers are particularly useful for identifying patients with high bone turnover who may benefit from antiresorptive therapy. The combination of BMD, clinical risk factors, and bone turnover markers improves the prediction of fracture risk and enhances the evaluation of osteoporosis.The assessment of fracture risk involves evaluating bone mineral density (BMD), clinical risk factors, and biochemical bone markers. BMD, measured by dual-energy X-ray absorptiometry (DXA), is the standard for diagnosing osteoporosis and assessing fracture risk, but it has limitations, such as not capturing bone geometry or microarchitecture. The Fracture Risk Assessment Tool (FRAX) uses clinical risk factors to predict fracture risk, which can be useful for patients with low BMD (T-score between -1.0 and -2.5) and a ten-year hip fracture risk of ≥3% or a ten-year major osteoporosis-related fracture risk of ≥20%. Biochemical bone markers, such as NTX, CTX, and bone-specific alkaline phosphatase, help monitor treatment efficacy and assess fracture risk. Bone turnover markers are particularly useful for identifying patients with high bone turnover who may benefit from antiresorptive therapy. The combination of BMD, clinical risk factors, and bone turnover markers improves the prediction of fracture risk and enhances the evaluation of osteoporosis.