Osteoporosis is the prevalent cause of fractures in an ever-aging population, with an established correlation between daily activities and way of life. We aimed to delineate differences in onset of osteoporosis, T-score progression, quality of life, and correlation to prevalence, types, and severity of fractures in age-comparable populations of rural and metropolitan habitats in this multicenter, retrospective double-blind study. We evaluated data derived from the medical files of two comparable groups of osteoporotic patients: group A (n = 530, rural area) and group B (n = 171, metropolitan area). Both groups received comparable treatment for osteoporosis. Comparison was performed on the basis of osteoporosis onset, T-score in a maximum of 8 years follow-up, fracture types [American Academy of Orthopaedic Surgeons (AO) categorization], and type of treatment followed. Quality of life was assessed by use of specialized questionnaires. From the minimum 4-year follow-up of all patients included in the research, there was a statistically significant difference in favor of the rural population in all research parameters. Rural populations presented with osteoporosis at a later age than their metropolitan counterparts, exhibiting favorable T-scores with comparable treatments and simpler fractures (AO categorization). Metropolitan habitats and life therein have a deleterious effect on osteoporosis onset and response to treatment. Rural populations are diagnosed with osteoporosis on a later age, with better compliance and improved treatment outcome. Fracture categorization shows increased severity in the metropolitan populace and a suggested correlation between a poor-quality way of life and decreased activity levels.