Bridging the Bone Gap: How a Fracture Prevention Service Can Keep You Strong
"Discover how a simple in-hospital program can significantly reduce your risk of future fractures and improve long-term bone health."
As we get older, our bones can become more fragile, leading to osteoporotic fractures. In Italy alone, 90,000 hip fractures occur each year in people over 50, and similar trends are seen worldwide. Unfortunately, many individuals don't receive the necessary follow-up care to prevent future fractures, creating a significant healthcare gap.
A fragility fracture at the hip is especially serious, increasing the risk of disability and even death. While treatments exist to reduce fracture risk, studies show that a surprisingly large number of people who've already had a fracture aren't receiving them. This is where a Fracture Prevention Service (FPS) can make a real difference.
This article explores how a tailored, in-hospital FPS can effectively bridge the osteoporosis care gap, helping those at high risk of future fractures receive the treatment and support they need. We'll break down the key components of an FPS and how it can improve long-term bone health.
A Silent Epidemic With Rising Fracture Burden
Fact-checked statistics published in 2026 report that osteoporosis affects an estimated 200 million people and accounts for 90 percent of hip fractures worldwide. The same data indicate that these fractures typically produce about six months of impaired mobility and raise one-year mortality risk by about 20 percent. The economic and social burden is projected to keep growing as America's population ages, with baby boomers reaching their golden years and healthcare systems facing increasing pressure to address the bone health crisis without stronger intervention and prevention. Broader tracking, such as the Global Burden of Disease collaborative analysis of bone and fragility fractures in 204 countries and territories from 1990 to 2019, provides the epidemiological foundation for these projections.
Risk Assessment Tools and the Care Gap
Modern management has shifted toward a more stratified approach to fracture risk, combining fracture assessment tools with bone mineral density measured using dual X-ray absorptiometry (DXA) scanning. The approach spans both primary and secondary fracture prevention, with fracture liaison services playing an important role in identifying and treating patients after a first fracture. Standard guidance such as The Clinician's Guide offers recommendations on prevention, risk assessment, diagnosis, and treatment for postmenopausal women and men aged 50 and older, including indications for bone densitometry and fracture risk thresholds for pharmacologic intervention. Despite these accepted methods, fewer than 20 percent of patients are appropriately treated for osteoporosis following a fracture, even though primary care guidelines consistently stress the importance of secondary fracture prevention.
From 'Porous Bone' to a Remodeling Disease
The term 'osteoporosis' translates literally to 'porous bone,' and rather than a single moment of discovery, understanding of the condition emerged gradually as clinicians shifted from observing its effects to defining its mechanisms. Strictly speaking, osteoporosis is a histological diagnosis in which the bone tissue is relatively normal but there is too little of it. Bone loss can progress silently for decades until fractures occur late in life, contributing to reduced bone strength and increased fracture likelihood. The modern mechanistic picture centers on continuous remodeling in which osteoclasts resorb old bone while osteoblasts synthesize new bone, while a major fracture history is itself a risk factor that measurably affects quality of life and general health status.
What is a Fracture Prevention Service (FPS)?
An FPS is a multidisciplinary, collaborative team that includes orthopedic surgeons, geriatricians, physical therapists, nurses, and general practitioners. This team works together to ensure you receive the necessary care to prevent future fractures.
- Identifying individuals at high risk of future fractures.
- Assessing your bone health through bone mineral density (BMD) testing and blood work.
- Providing appropriate treatment, including medication and lifestyle recommendations.
- Connecting you with outpatient primary care physicians for ongoing care.
New Medications and Rapidly Evolving Therapy
Osteoporosis management is evolving rapidly beyond traditional therapies, and a December 2025 review highlights both emerging medications and novel therapeutic targets aimed at protecting bone strength and retarding bone loss. Among the new medications identified are romosozumab, cinacalcet, and tiliroside, alongside emerging questions about how to sequence traditional and novel pharmacological approaches. The review also notes that rheumatological patients are at particularly high risk of osteoporosis and fracture due to disease, treatments, comorbidity, and physical and functional considerations, making optimal treatment paramount. Ongoing research, including a 2026 Frontiers research topic on recent advances in prevention, diagnosis, and treatment, is investigating how macro- and micronutrient intake affects bone mineral density, osteoporotic fracture risk, inflammation, and functional rehabilitation outcomes in orthopedic patients.
Critical Unmet Needs in Fracture Prevention
A widely cited review of critical issues in osteoporosis and fracture prevention describes osteoporosis as a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality are the hallmarks of the condition, which leads to an increased risk of fragility fractures in the elderly. The review examines the topics that play a role in the occurrence and prevention of fractures, offering an overview of the critical issues and challenges that remain around osteoporosis and fracture prevention, including treatment gaps and unmet needs.
Network Meta-Analysis of Anti-Osteoporosis Medications
Comparative evidence on osteoporosis treatment comes from a systematic review, network meta-analysis, and meta-regression analysis of randomized clinical trials that assessed fracture risk reduction and safety by osteoporosis treatment compared with placebo or an active comparator in postmenopausal women. A summary published in May 2023 by OBG Project examines how different anti-osteoporosis medications compare in fracture risk reduction. This head-to-head framework gives clinicians a relative view of how medications perform against one another in the same patient population when deciding on treatment.
The Bottom Line: Taking Control of Your Bone Health
The study clearly shows that an FPS is an effective way to improve the identification and management of older adults at high risk for fragility fractures. By optimizing clinical management and increasing adherence to prescriptions, an FPS can help you take control of your bone health and reduce your risk of future fractures.
Widely Available Therapies, Largely Underused
A Lancet Seminar published in October 2025 frames osteoporotic fractures as one of the most common and consequential diseases of advanced ageing, noting that many antifracture therapies are widely available but largely underused. The Seminar presents an updated approach to the osteoporosis consultation, drawing on published evidence and collaborative expert opinion to place the data in a pragmatic and useful context for clinicians. It also incorporates new evidence to help close the gap between available treatments and their actual use in practice.
The Next Decade: Bone-Building Agents and Broader Tools
Osteoporosis is projected to increase in magnitude as a global public health problem over the next 10 years, yet the field now has substantial advances in diagnosis and treatment from the last decade, along with the knowledge and instruments to tackle the disease. A 2026 review maps the evolving landscape of therapies, from proven bisphosphonates to next-generation bone-building agents and emerging treatments. Together, these outlooks point toward a broader, more individualized therapeutic armamentarium in the coming decade, provided that new agents reach patients alongside stronger detection and follow-through.
A Systems-Level Problem Beyond Any Single Visit
Fracture prevention is also a systemic challenge that depends on how healthcare organizes screening, medication access, and follow-up after an initial fracture. Gaps anywhere in that chain, from missed diagnosis to interrupted treatment, can leave at-risk patients unprotected, so coordinated approaches that connect detection with treatment and sustained monitoring are generally considered essential. Making real progress will likely require integrating fracture prevention into routine care across settings rather than leaving it to individual encounters alone.
Real-World Patient Stories and Practical Lessons
Real-world case studies illustrate how osteoporosis often surfaces unexpectedly, exemplified by the case of a 'silent fracture' in which the condition was discovered only after a bone broke with little warning. In these accounts, basic prevention measures such as weight-bearing exercise (even walking) and sunlight exposure for vitamin D are described as non-negotiable parts of the care plan. Clinicians apply risk stratification techniques to categorize patients as high versus very high risk of fracture, then build comprehensive treatment plans that include lifestyle, nutritional, fall prevention, and pharmacologic interventions. Case-based discussion helps individualize osteoporosis care across a diverse patient population, reinforcing that early detection and tailored follow-up drive better real-world outcomes.
While the study had some limitations, including being an observational pre-/post-intervention design, the results are promising. The increase in therapeutic and diagnostic antifracture recommendations suggests that coordinated systems of care can make a real difference in patient outcomes.
If you're concerned about your bone health or have experienced a fracture, talk to your doctor about whether an FPS is right for you. Taking proactive steps to protect your bones can help you stay strong and independent for years to come.