Background. Medical, social and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. Materials and methods. 1161 menopausal women aged 50–79 years were examined and divided into three groups: group A included 419 women with increased body weight (body mass index (BMI) — 25.0–29.9 kg/m²), group B — 442 females with obesity (BMI > 29.9 kg/m²) and group C — 300 women with metabolic syndrome (diagnosis according to International Diabetes Federation criteria, 2005). Dual-energy X-ray absorptiometry (Prodigy, GE Medical systems, Lunar, Madison, WI, USA, 2005) was used for measuring lumbar spine (L₁-L₄), femoral neck, total body and forearm BMD and bone quality indexes (last using Medimaps software). Data were analyzed using Statistica 6.0 package. Results. A significant increase of lumbar spine (L₁-L₄), femoral neck, total body and ultradistal radius BMD was found in women with obesity and metabolic syndrome compared to the pre-obese ones (p < 0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed a significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association was found between serum high-density lipoproteins (HDL) level and BMD of investigated sites. Conclusions. The TBS (L₁-L₄) indexes positively correlated with HDL level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.

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