Key PointsQuestionIs prediabetes associated with increased fracture risk among midlife women?FindingsIn this cohort study of 1690 midlife women without diabetes from the Study of Women’s Health Across the Nation cohort, relative to not having prediabetes at any visit before the menopause transition (MT), having prediabetes at every pre-MT visit was associated with a statistically significant 120% greater hazard for fracture during the MT and after menopause. This association was independent of bone mineral density at the start of the MT.MeaningThis study suggests that, for midlife women, prediabetes may be a risk factor for future fractures.