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Background:  Osteoporosis is a significant risk factor for morbidity, and its high prevalence among Saudi women should be considered to be a public health problem. Quantitative ultrasound was recommended for bone mineral density (BMD) screening. Receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) and their ratio are critical for physiological bone remodelling, and related abnormalities may lead to several osteopathies.\ud\udMethods: The BMD of 499 Saudi females aged 20 to 65 years was measured using quantitative ultrasound from the beginning of October 2013 to the end of March 2014 at the female medical unit of Taibah University, Madinah, KSA. Possible associated risk factors for low BMD were studied. Blood RANKL and OPG were measured by enzyme-linked immunosorbent assay (ELISA).\ud\udResults: No significant differences were found between participants with normal and low BMD regarding the studied risk factors. However, there was a significant association (p < 0.05)  between BMD and regular physical activity among participants aged 20 years to less than 35 years, and women aged 35–50 years with higher body mass index (BMI) had higher BMD. The RANKL/OPG ratio was inversely associated (p = 0.04) with BMD.\ud\udConclusions: Regular physical activity is crucial for maximizing BMD in young females and decreasing the possibility of developing osteoporosis with ageing. The RANKL/OPG ratio might be considered a useful and easy-to-use tool for the prediction of low BMD

Parallel Assessment of Bone Mineral Density and RANKL/OPG Ratio in Saudi Females