Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic studies in men. Potential risk factors for osteoporotic fractures were assessed in 220 elderly men aged 60 years or above in the city of Dubbo (Australia). During the follow-up period of 1989-1994, the overall incidence of fractures (determined from x-ray reports) was 220 fractures per 10,000 person-years. Higher risk of fracture was associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity, and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model), femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (CI) 1.25-1.73 per 0.12 g/cm2), quadriceps strength (OR = 1.43, 95% CI 1.18-1.73 per 10 kg), and body sway (OR = 1.25, 95% CI 1.07-1.45 per 5.15 cm2) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence of osteoporotic fracture and hence improve the survival among men.