Osteoporosis is the most common chronic metabolic bone disease related to various factors including menopause and aging. Since bone turnover is increased, the metabolic activity changes. These alterations lead to net-loss of bone tissue, with decreased structural connectivity and apparent density, which subsequently results in a weaker structure. Fragility fractures are the clinical outcome of osteoporosis. Bone mineral density (BMD) measurement or the development of algorithms such as Fracture Risk Assessment Tool Model are two ways to estimate the fracture risk, but their predictive capabilities are still limited. Hence, a more detailed evaluation of pathological risk of fracture is needed. In the present thesis, I aimed to improve predictions of bone damage and fracture.