Abstract <p>This prospective study of 784 elderly women found that age, high fall risk, and frailty increase refracture risk after fragility fracture surgery, whereas family support, hemoglobin, and albumin levels are protective, highlighting the need for comprehensive geriatric assessment.</p> Background <p>The incidence of fragility fractures is high among elderly women, and the risk of secondary fractures significantly increases after the first fracture, leading to higher mortality rates, complications, and socioeconomic burdens. Identifying risk factors for refracture is crucial for prevention. However, there is currently limited analysis of risk factors for postoperative refracture in elderly women in China.</p> Objective <p>The objectives of this study were to investigate the incidence of recurrent fractures within 2 years after surgery for fragility fractures in elderly women and to identify associated risk factors.</p> Methods <p>This prospective observational study enrolled 784 elderly female patients undergoing surgery for fragility fractures at three hospitals in Shandong Province, China, between January and December 2022. Data of a total of 33 variables were collected, including demographic characteristics, comorbidities, laboratory indicators, fall risk, frailty status, family support, and medication use. Univariate analysis and binary logistic regression were used to identify factors associated with refracture within 2 years post-surgery.</p> Results <p>A total of 53 patients (6.76%) experienced refracture within 2 years post-surgery. Multivariate analysis revealed that advanced age (OR = 1.103), high fall risk (OR = 7.907), and frailty (OR = 1.482) were independent risk factors for postoperative refracture. Conversely, living with family (OR = 0.416), higher hemoglobin levels (OR = 0.975), higher serum albumin levels (OR = 0.895), and stronger family support (OR = 0.891) were protective factors against refracture.</p> Conclusions <p>Preventing postoperative refracture in elderly women with fragility fractures requires a systematic approach. Clinical practice should incorporate comprehensive geriatric assessments, routinely including fall risk evaluation, frailty screening, and nutritional status assessment, while emphasizing and leveraging family support systems. It is recommended to integrate fall prevention education, frailty intervention, nutritional support, and family involvement into standard fracture liaison services, forming multidimensional, individualized management strategies to effectively reduce refracture risk.</p>