On a sweltering Sunday morning in August 2022, Gaynor Fraser stood near her husband at the rear of the church when unexpectedly, she collapsed. She believed it was due to the intense heat, dehydration, and possibly a sudden dip in blood pressure.
blood pressure
Right away, she was in excruciating pain – Gaynor usually had a very high tolerance for discomfort and had given birth to two children with minimal pain medication, but this time she was screaming loudly.

“I remember looking at my legs, seeing that my left was shorter than my right and my foot was externally rotated,” she says. As a retired nurse, she knew that her hip was broken. The ambulance arrived after 90 minutes, and once in hospital, the nerve blocks she was administered actually made the pain worse. “By then, I was literally asking them to shoot me,” she says.

Up until that day, Gaynor, at age 60, remained fit and active. Following her retirement from nursing, she took up a role as a healthcare assistant. Cycling, hitting the gym, and walking with such speed that her spouse nicknamed her “the whippet” were part of her routine. Whether driving or taking the train, she frequently journeyed from her house in Northumberland down to Hampshire to see her son, who lives with autism and mental health issues.

Everything shifted abruptly. Actually, Gaynor did not lay eyes on her son for the subsequent eight months. Her journey towards recovery included two surgeries, frequent physical therapy (ultimately, she opted for private sessions for PT), and twenty months away from her job. Nearly two years post-accident, Gaynor was still using a cane when moving around. Amidst all these challenges, she discovered the true cause behind the bone breakage. It turned out that Gaynor suffered from severe osteoporosis which remained undiscovered.
osteoporosis
, her bone density had dropped so significantly that she faced an elevated danger of fracturing yet another bone. As though she’d leaped two decades ahead into fragility and seniority. “My anxiety reached unprecedented levels,” she recounts. “I felt burdensome. The thought of venturing outside petrified me.”

However, Gaynor had ample reasons to feel worried. Approximately one-third of individuals who suffer a hip fracture pass away within a year, with about 10 percent dying within a mere month. Among those who experience a hip fracture while residing at home, between 10 and 20 percent end up transitioning into institutionalized care. Fractured bones are not merely short-term inconveniences; they rank as the fourth leading contributor to disabilities and early deaths in the UK and account for the second highest occupancy rate among adult hospital beds. Often, untreated osteoporosis is behind these fractures—yet according to YouGov’s findings, 52 percent of people haven’t even contemplated the possibility that they could be affected by this condition.

Women are particularly at risk – approximately half of women aged 50 and above are anticipated to suffer from bone fractures due to osteoporosis (in contrast to one-fifth of men). This condition leads to complications that result in fatalities among as many women as
breast cancer
. There are effective preventative treatments but few women realise they might need them, nor is there a national screening system to identify those at risk. For this reason, experts believe middle aged women are sitting on a bone health time bomb.

What makes women more vulnerable?

Dr. Nicky Peel, a consultant specializing in metabolic bone disease and a trustee for the Royal Osteoporosis Society, explains that both men and women begin with comparable bones and reach their highest bone mass in their thirties. By that time, males generally exhibit larger skeletal frames and higher bone density due to hormonal changes during puberty. This difference makes male bones comparatively more robust as they experience a slower decline associated with aging. For females, however, this natural decrease is accelerated significantly after menopause.
the menopause
Early onset of menopause is a specific risk factor.

We often view bones as mere skeletal structures, but in reality, they are quite dynamic and active,” explains Dr. Peel. “Throughout our lives, bones continually undergo remodeling, where old bone tissue is removed and replaced by new bone. Estrogen has a crucial part in this process; hence, during menopause,
menopause
when oestrogen levels decline, there’s a period of three to five years where bone renewal really falls behind the rate of bone loss. It can add up to quite a big deficit.”

Age is another factor. Women tend to live longer and are more likely to experience the lower bone strength that comes with old age.

Additional risk factors

Diet

Over the past two decades, data reveals a notable decline in the consumption of essential nutrients in the UK. The Health and Food Supplements Information Service reports that calcium and folate intakes have each decreased by 10 percent, whereas vitamin D consumption has dropped by over 20 percent. Calcium plays a crucial role in forming bones; however, various nutrients are necessary for absorbing and utilizing it effectively.

Lifestyle

Dr. Peel explains, “Our bones become more robust with usage.” He adds, “A stagnant way of life, staying indoors continuously without exposure to sunlight for Vitamin D, and increased indoor work environments can affect our skeletal system negatively. Studies also indicate an increase in alcohol consumption.” These factors impede the renewal of bone cells, hinder the assimilation of vitamins, and reduce the levels of estrogen and testosterone—essential elements for maintaining healthy bones.

Smoking also diminishes the formation of new bone tissue, and
research
has shown an increase in smoking among middle-income women.

Other medical issues and drugs

“Various health issues can boost the risk of osteoporosis, such as those impairing nutrient absorption like Crohn’s disease or celiac disease,” explains Dr. Peel. “Additionally, numerous medicines can influence bone health, including corticosteroids used for asthma.”
arthritis
.”

Family history

Genetics also play a role. If one of your parents has had a hip fracture, this poses a considerable risk.

What steps should you take for assessment?

There are effective treatments available to decelerate the breakdown of bones, accelerate bone regeneration, and decrease the likelihood of additional fractures by 50 to 90 percent. Nonetheless, the systems for identifying individuals who require these treatments are inconsistent and vary depending on location. This observation comes from the Health and Social Care Secretary.
Wes Streeting
promised to address this issue through a nationwide implementation of “fracture liaison services.” He stated that it would be among his top priorities initially; however, after five months in office, these efforts have not yet materialized.

Many specialists advocate for focused evaluations, targeting individuals who are particularly vulnerable, inviting them to undergo a bone density test using Dual Energy X-ray Absorptiometry (DEXA). This scan provides a T-score with anything above -1 being deemed healthy and levels below -2.5 indicating osteoporosis. Additionally, you can gauge your personal risk via the tools offered by the Royal Osteoporosis Society.
risk checker
Anyone concerned about being at high risk should consult their general practitioner regarding a Dexa scan or, at minimum, undergo a risk assessment using the Frax tool. This evaluates numerous factors to determine the ten-year likelihood of experiencing an osteoporotic fracture.

Despite nearly being overlooked for a proper diagnosis, even Gaynor faced challenges. After suffering a broken hip from falling at standing height, she wasn’t immediately referred for a Dexa scan. There was also no conversation regarding her bone health or what caused the fracture. When she later inquired with the orthopedic surgeon who performed her surgery as to why this occurred, his response was, “Bone health isn’t our concern; we simply repair your injuries.”

Gaynor was ultimately moved to the geriatric care unit solely due to the sluggish pace of her recuperation. It was at this point that she underwent a Dexa scan. She received the scan in October and was informed, “If you haven’t gotten any news, it indicates all is well.” By December, having not heard back, she chose to follow up. It wasn’t until she pursued the matter that her general practitioner called anxiously to inform her about her diagnosis of osteoporosis.

In January, Gaynor was referred to a rheumatologist. Eventually, in May of the previous year—nine months following her accident—she started receiving treatment with romosozumab. Various elements might have contributed to increasing her susceptibility. Her mother suffered a broken wrist when she reached her sixties, which suggests genetics could be involved. Additionally, Gaynor is an
vegan
And she has started taking Vitamin D and calcium supplements. Her most recent Dexa scan indicates an improvement in her bone density.

Ways to Safeguard Bone Health

We can adopt various measures to safeguard our bone health. As stated by Dr. Peel, “Maintaining a nutritious diet rich in calcium, an adequate intake of proteins, along with plenty of fruits and veggies, plus Vitamin D supplements to aid in calcium absorption, is crucial.” Regular physical activity, particularly exercises involving weight-bearing and strength training, contributes significantly to building robust bones. Additionally, limiting alcohol intake and avoiding tobacco use play vital roles. For women experiencing premature menopause, hormone replacement therapy (HRT), which simulates estrogen levels and decreases fracture risks, may be considered essential.

For Gaynor, the road to recovery continues. “For quite some time, I depended entirely on my spouse for every task—preparing meals, managing household chores, even transportation. He practically had to pick me up just to get me into bed. After 28 weeks, my statutory sick pay ran out, leading to significant financial strain as well.”

Eight months following my initial surgery, I was reliant on two crutches. Later, I required just one cane. Currently, I walk without assistance but have a minor limp.

This year, Gaynor resumed her job in April. She has taken up cycling once more and frequents the gym two to three days per week. “I remain vigilant,” she shares. “When conditions are slippery, I’m extra cautious. There’s always a part of me wondering whether it could recur? I am particularly mindful of potential tripping risks and avoid working in the emergency room due to its high activity levels. The fear persists that somebody might bump into me.”

But I’m escaping from the house, I visit my son once a month, and I’ve regained my sense of self. Everything about this is fantastic. I never expected to feel like this.
bone health
A thought, yet my life transformed instantly. I no longer take it for granted now.”

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