text: As widely reported in the scientific literature, bone density is just one of the components of bone strength thus it only partially predicts bone fragility. In order to overcome this limitation, a novel parameter, Fragility Score, has been developed. Fragility Score evaluates bone microstructural features independently from BMD and it is based on the assumption that a fragile bone structure has microstructural features which, in turn, influence the spectral characteristics of the acquired ultrasound signal, being different from those reflecting a robust bone structure. Fragility Score is an adimensional parameter, ranging from 0 to 100, obtained by comparing the spectra of the acquired ultrasound signals with the spectral reference models obtained from patients who did, or did not, developed an osteoporotic fracture. This parameter has been validated through clinical studies and its accuracy has demonstrated a performance similar to DXA BMD.