Written by Sneha Kamat, Senior Physiotherapist APPI Clinics.
Osteoporosis is a common condition that causes bones to become weaker and more fragile over time. This means they can break more easily, often from simple everyday events such as slipping, tripping, lifting or even coughing. These are called fragility fractures.
Osteoporosis is sometimes called a “silent condition” because you can’t feel your bones getting weaker and the first sign is often a fracture. That is why knowing who is at risk and when to assess fracture risk is so important.
How Common Is Osteoporosis?
- Osteoporosis becomes more common as we age.
- Around 2% of people have osteoporosis at age 50, but this rises to nearly 50% by age 80.
- In England and Wales, over 2 million women are living with osteoporosis.
- Each year, around 180,000 fractures seen in hospitals are caused by osteoporosis.
- More than 1 in 3 women and 1 in 5 men, will sustain at least one osteoporotic fracture in their lifetime.
- Although osteoporosis affects everyone, studies show that white men and women are at higher risk of fragility fractures compared with other ethnic groups.
- Some fractures – especially vertebral (spine) fractures – often go undiagnosed. These can cause height loss, stooping or ongoing back discomfort, but many people do not realise they have fractured a vertebra. Most of these “hidden” fractures are caused by osteoporosis and significantly increase the risk of further fractures.
Who Should Be Assessed for Fracture Risk?
Professional guidelines recommend assessing fracture risk for anyone who is more likely to have low bone density or a fragility fracture. This helps identify individuals who may benefit from lifestyle changes, targeted exercise or medical treatment.
Assessment is recommended for:
- Women aged 65 and over
- Men aged 75 and over
Women under 65, men under 75 should also be assessed if they have any of the following:
- A previous fragility fracture
- Current or frequent steroid use (tablets or strong doses)
- A history of falls
- A family history of hip fracture
- Low BMI (under 18.5 kg/m²)
- Smoking
- High alcohol intake (over 14 units per week)
- Early menopause or low hormone levels
- Diabetes, thyroid disease, Cushing’s, or hyperparathyroidism
- Coeliac disease, inflammatory bowel disease or malabsorption
- Rheumatoid arthritis or other inflammatory conditions
- Chronic kidney, liver, or lung disease
- Blood conditions such as myeloma
- Long periods of immobility
People under 50
Risk assessment is not usually routine unless they have major risks such as:
- Long-term high-dose steroids
- Untreated early menopause
- Multiple or major fragility fractures
Why These Factors Increase Risk
Bones are constantly renewing themselves. Anything that reduces bone building (osteoblastic activity) or increases bone breakdown (osteoclastic activity) can decrease bone strength.
Certain factors that matter are:
- Age: Bone composition can naturally change with time. Women may experience faster bone changes after menopause.
- Previous fragility fracture: Having had a fracture before can offer useful insight into your bone health. It helps healthcare professionals identify where extra support or prevention strategies may be most beneficial to keep your bones strong in the future.
- Steroids: These medications can influence the body’s natural bone-remodelling process.
- Low BMI: Often linked with poor nutrition and low muscle mass.
- Smoking & alcohol: Both negatively affect bone quality.
- Medical conditions: Many illnesses disrupt hormones, calcium absorption or bone turnover.
- Falls: When a fall happens, bones that are not at their strongest may be more vulnerable to injury.
- Medications: Some drugs (SSRIs, antiepileptics, PPIs, aromatase inhibitors, GnRH agonists) can reduce bone strength.
Understanding these factors helps guide who needs assessment and who can benefit from early prevention.
How Fracture Risk Is Assessed
Clinicians use validated tools such as FRAX or QFracture to calculate your personal 10-year fracture risk.
These tools consider age, lifestyle, medical history and sometimes a bone density scan (DEXA).
Your result may fall into:
- Low risk – advice on lifestyle, exercise and follow-up
- Intermediate risk – may need a DEXA scan
- High risk – may benefit from medication alongside exercise and lifestyle measures
At APPI, we can help support safe, appropriate exercise for bone health regardless of your risk level.
How Exercise & Pilates Can Help
While medication may be needed for some individuals, exercise is essential for everyone. Weight-bearing, strength, balance, impact and posture work all help improve bone strength and reduce falls – two of the most effective ways to prevent fractures.
Regular exercise can help:
- Improve strength to support the bones better
- Enhance balance and prevent falls
- Build confidence in movement
- Reduce pain and move better
- Support posture, especially for spinal health
APPI offers a safe, adaptable exercise approach for people of all ages and abilities.
Takeaway
Osteoporosis and fragility fractures are common, serious and often silent – but the good news is that early assessment and the right exercise programme can make a huge difference.
If you have any of the risk factors above or you are unsure whether you should be assessed, speak to a healthcare professional. If you would like tailored exercise-based support for bone health, we would be happy to help.
Our Pilates for Osteoporosis class
We are delighted to offer a safe, Physio-led, Pilates class designed for individuals managing osteoporosis or osteoarthritis. The session combines structured mat Pilates with functional strength training to support bone health, joint mobility, postural control and overall functional capacity. Exercises are low-impact, carefully supervised and adaptable to all abilities. Suitable for anyone seeking a safe, targeted approach to maintaining strength, stability and general confidence in daily movement. Mondays at 1pm at our Wimbledon clinic with our Senior Physiotherapist Sneha Kamat.
Please call us on 0208 879 7711 or email at wimbledon@appiclinics.com to book your place or speak with one of our physiotherapists to find out more. Bookings through our website can be made here
References
National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture (CG146). NICE, London.
NICE Clinical Knowledge Summaries (CKS). Osteoporosis – prevention of fragility fractures. NICE.
National Osteoporosis Guideline Group (NOGG). Clinical guideline for the prevention and treatment of osteoporosis. 2024 update.
Kanis JA, Harvey NC, Johansson H, et al. FRAX® and fracture prediction without bone mineral density. Osteoporosis International.
Lorentzon M, Cummings SR. Osteoporosis and fracture epidemiology. Osteoporosis International, 2022.
Yu M, Zhou P, Che Y, et al. The efficacy of exercise prescription in patients with osteoporotic fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025;20:250. doi:10.1186/s13018-025-05636-z