Fragility fracture: what it means, why bones break and how to prevent the next one

A fragility fracture is a broken bone that happens with much less force than would normally be needed, such as a fall from standing height or a minor knock. The term is usually used about people whose bones have become fragile because of osteoporosis, which the NHS describes as a condition that weakens bones, making them fragile and more likely to break.

The NHS says osteoporosis develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break. It is not usually painful until a bone is broken, although broken bones in the spine are a common cause of long-term pain. For many people, then, the fracture is the first sign that bones have weakened, which is why a fracture after a minor fall deserves a bone health assessment as well as treatment of the injury.

Fractures can occur in any bone. The most common injuries the NHS lists are a broken wrist, a broken hip and broken spinal bones, though breaks can also happen in the arm or pelvis. Some older people develop a stooped posture because bones in the spine have broken and make it hard to support the weight of the body.

The NHS explains that bones are thickest and strongest in early adult life until the late 20s, and that you gradually start losing bone from around the age of 35. This happens to everyone, but some people lose bone much faster than normal and are at greater risk of fracture.

Women are more at risk than men because hormone changes at the menopause affect bone density; falling oestrogen after the menopause can lead to a rapid decrease in bone density. The risk is higher with an early menopause (before 45), a hysterectomy before 45, particularly when the ovaries are removed, or absent periods for more than 6 months from over-exercising or too much dieting. In men the cause is often unknown, but low testosterone is linked, and known causes include steroid tablets, alcohol misuse and hypogonadism.

• Taking high-dose steroid tablets for more than 3 months.

• Inflammatory conditions such as rheumatoid arthritis, hormone-related conditions such as an overactive thyroid, and malabsorption problems such as coeliac disease or Crohn's disease.

• A family history of osteoporosis, particularly a hip fracture in a parent.

• A low body mass index (the NHS gives 19 or less), an eating disorder, heavy drinking and smoking, and not exercising regularly.

• Long-term use of medicines that affect bone strength or hormone levels, such as anti-oestrogen tablets after breast cancer.

If a doctor suspects osteoporosis, the NHS says they can work out your future risk of breaking a bone using an online programme such as FRAX or Q-Fracture, which take account of factors such as age, sex and previous fractures. They may also refer you for a bone density scan (DEXA scan) to measure bone strength. It is a short, painless procedure that takes 10 to 20 minutes depending on the part of the body being scanned.

The result is compared with a healthy young adult and given as a T score. A T score above -1 is normal, between -1 and -2.5 shows bone loss and is defined as osteopenia, and below -2.5 is defined as osteoporosis. Osteopenia does not always lead to osteoporosis, and the NHS says doctors may still prescribe bone-strengthening medicines depending on how weak the bones are and the risk of breaking a bone.

The NHS says treatment is based on treating and preventing broken bones and taking medicine to strengthen bones. The decision about what treatment you need depends on your risk of breaking a bone, based on age, sex, previous injury history and the bone scan. If you have broken a bone you should still receive treatment to reduce the risk of further breaks, and everyone should make sure they get enough calcium and vitamin D.

• The NHS advises taking bisphosphonate tablets on an empty stomach with a full glass of water, standing or sitting upright for 30 minutes afterwards.

• A rare side effect of bisphosphonates is osteonecrosis of the jaw, most often with high-dose intravenous treatment for cancer rather than for osteoporosis; people with dental problems may need a check-up first.

Because fragility fractures usually follow a fall, preventing falls matters as much as strengthening bone. The NHS suggests removing hazards from the home and having regular sight tests and hearing tests. NICE guideline NG249, published in April 2025, covers assessing the risk of falling and interventions to prevent falls in people aged 65 and over and in those aged 50 to 64 who are at higher risk, with the aim of reducing falls and the associated pain, injury, loss of confidence and loss of independence.

To help recovery from a fracture the NHS suggests painkillers, hot and cold treatments such as warm baths and cold packs, and relaxation techniques. Taking regular exercise, eating foods rich in calcium and vitamin D, taking a daily supplement of 10 micrograms of vitamin D, giving up smoking and reducing alcohol all help to keep bones healthy.

The NHS notes that the Royal Osteoporosis Society is the UK's national charity for osteoporosis, with information and support groups across the UK and a helpline that may help people who are newly diagnosed.

After a fracture, the NHS usually deals with the injury through urgent care, orthopaedics or fracture clinics and then assesses bone health through a GP, a fracture liaison service or a specialist clinic. Scans, assessment and the medicines described above are free at the point of use for those eligible.

Some people pay privately for a DEXA scan or an endocrinology or rheumatology opinion. The result is the same T score, and it is helpful to share it with your GP so that the risk assessment and any treatment are coordinated.