About half of fragility fractures occurs in individuals without osteoporosis defined according to bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA). One hypothesis is that part of the alterations of bone microstructure may not be captured by this tool. High resolution peripheral quantitative computed tomography allows a non-invasive quantification of the geometric, microarchitectural, densitometric, and mechanical properties of cortical and trabecular bone at the distal radius and tibia. In this thesis, we illustrate how the various components of peripheral bone microstructure are associated and predict fragility fractures, compared to the performances of the current tools used in clinical practice. We also show to what extent bone microstructure and strength can be influenced by modifiable environmental factors such as physical activity, diet, or comorbidities and their treatments. Last, we evaluate and discuss the value of alternative and more accessible noninvasive imaging techniques to predict fractures.