Background: Menopause marks the cessation of reproductive life in women and brings hormonal changes that influence bone metabolism. Decline in estrogen levels accelerates bone loss, predisposing women to osteoporosis and fracture risk.

Aim: To assess the prevalence and risk factors of osteoporosis among postmenopausal women residing in a selected community of Chennai.

Methods: A descriptive correlational study was conducted among 75 postmenopausal women residing in Ayanambakkam village, Chennai. Participants fulfilling inclusion criteria were selected by consecutive sampling. Data were collected using validated instruments-demographic, health, and menstrual variables proformas, and the Fracture Risk Assessment Tool (FRAX® online calculator). Statistical analysis included frequency, percentage, mean, standard deviation, and Chi-square tests.

Results: Most participants were aged 55-59 years (67%) with mean ± SD = 55.36 ± 3.42. Majority had normal BMI (68%) and moderate physical activity (68%). About 27% had diabetes mellitus and 28% had hypertension. FRAX analysis revealed that 72% had low risk for hip fractures and 67% had low risk for major osteoporotic fractures. Mean ± SD of 10-year probability of hip fracture (without BMD) was 2.12 ± 2.55 and for major osteoporotic fracture was 9.98 ± 9.16. Risk level was significantly associated with age (p = 0.009), activity (p = 0.016), medical illness (p = 0.0008), number of children (p = 0.006) and age at menopause (p = 0.0162).

Conclusion: Most postmenopausal women exhibited low fracture risk; however, older age, early menopause, higher parity, medical comorbidities, and moderate-to-heavy physical activity increased the probability of osteoporotic fractures. Nursing professionals play a vital role in screening, education, and lifestyle modification programs to prevent osteoporosis.