Abstract: Objective：To estimate the incidence of major clinical osteoporotic fractures as well as its relevant risk factors in urban and rural community dwelling elderly women in Shanghai. Methods：A total of 2 033 women from urban community and 2 395 women from rural community were enrolled from the Prevention of Elderly Osteoporotic Fracture study. Questionnaire investigation and clinical physical examination were performed. Calcaneus quantitative ultrasound (QUS) bone mineral density (BMD) was measured. Performance assessment included timed up and go test (TUG), five timed chair rising test (CRT), tandem standing test (TGT). Results：The prevalence of total osteoporotic fractures in urban elderly women was higher than that of rural ones (26.27% vs 21.67%, P<0.01). The percentage of clinical vertebral osteoporotic fractures in urban elderly women was higher than that of rural ones (18.35% vs 12.14%), whereas the percentage of extremity fractures in rural elderly women was higher than that of urban ones (79.77% vs 73.78%, P<0.01). Age, high education level, parental hip fracture, milk intake, calcium supplement, T score of QUSBMD, the incidence rate of falls, the time of both TUG and CRT as well as the prevalence of chronic obstructive pulmonary, gastrointestinal diseases, and cardiovascular diseases in urban elderly women were higher than those of rural elderly women (P<0.01 or 0.05). The proportion of long time physical activity in urban elderly women was less than that of rural ones (P<0.001). Stepwise logistic regression showed that factors such as elder age, parental hip fracture, the history of falls in recent 1 year, long completion time for TUG test were risk factors for osteoporotic fractures in urban elderly women, whereas higher T score of QUSBMD was protective factor. In rural elderly women, elder age, the history of falls in recent 1 year, long completion time for TUG test were risk factors, whereas long time physical activity was protective factor for osteoporotic fracture. Conclusions：The prevalence of total osteoporotic fractures in urban elderly women is higher than that of rural ones. Falls and age are vital risk factors for both urban and rural elderly women. We should pay more attention to the difference of risk factors in urban and rural elderly women, which might be important for the prevention of osteoporotic fractures.