Yong-Fang Li,1,* Qin-Yi Wang,1,* Lu-Lu Xu,2 Chun Yue,2 Li Hu,2 Na Ding,1 Yan-Yi Yang,2 Xiao-Li Qu,1 Zhi-Feng Sheng1,2 1National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China; 2Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi-Feng Sheng, Tel +86-13574806523, Email shengzhifeng@csu.edu.cnPurpose: Fragility fractures, the most serious complication of osteoporosis, affect life quality and increase medical expenses and economic burden. Strategies to identify populations with very low bone mineral density (T-scores