Postmenopausal women (PW) are at a significantly increased risk of fractures, largely due to estrogen deficiency leading to osteoporosis and altered bone quality. Fracture risk assessment is critical for early intervention and prevention strategies. This review explores advancements in fracture risk evaluation, highlighting experimental methodologies, clinical applications and emerging technologies. Key advanced imaging approaches include the use of dual-energy X-ray absorptiometry (DEXA) for bone mineral density (BMD) measurement, high-resolution peripheral quantitative computed tomography (HR-pQCT) for micro-architectural assessment and biochemical markers like C-terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (PINP) for monitoring bone mass density. Fracture risk assessment (FRA) tools such as FRAX and the Garvan calculator provide practical frameworks for estimating fracture probability by integrating clinical risk factors and BMD data. However, challenges remain. Including limited access to advanced imaging, variability in biochemical marker and under representation of diverse populations in validation studies. Future directions emphasize integrating artificial intelligence, expanding population specific validations and combining imaging with dynamic bone mass density data. This comprehensive review emphasizes the significance of a multidisciplinary approach in FRA, aiming to enhance precision, accessibility and clinical outcomes in postmenopausal women.