One hot Sunday morning in August 2022, Gaynor Fraser was standing at the back of church beside her husband when suddenly she keeled over. She thought it was the heat, dehydration and a drop in blood pressure. Instantly, she was in agony – Gaynor has a high pain threshold and gave birth to two children with little pain relief but now she was screaming.
“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.
Until that day, Gaynor, then 60, was fit and active. After stepping back from nursing, she began working as a healthcare assistant. She cycled, went to the gym and walked so fast that her husband called her “the whippet”. She regularly jumped in the car or train to travel from her Northumberland home to Hampshire to visit her son who has autism and mental health problems.
All this changed in an instant. In fact, Gaynor didn’t see her son for the next eight months. The recovery process took two operations, regular physio (in the end, she went private for physio) and 20 months off work. Gaynor was still walking with a stick almost two years after the accident and in the midst of all this, she learnt the real reason for the fracture. Gaynor had severe undiagnosed osteoporosis, with bone density so low that she was at high risk of breaking another bone. It was as if she’d been catapulted 20 years forward into frailty and old age. “My anxiety was sky high,” she says. “I felt like a burden. I was terrified of going out.”
But Gaynor had every reason to be anxious. A third of people who fracture their hip die within a year, and 10 per cent die within a month. Between 10 and 20 per cent who fracture a hip when living at home will move to institutional care. Broken bones aren’t just a temporary inconvenience. They are the fourth worst cause of disability and premature death in the UK and the second greatest filler of adult hospital beds. Untreated osteoporosis is usually the cause – yet YouGov research found that 52 per cent of people have never considered they might have it.
Women are especially vulnerable – half of women over the age of 50 are expected to break a bone because of osteoporosis (compared to one fifth of men). The complications caused by this condition kill 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.
Why are women most at risk?
Dr Nicky Peel, a consultant in metabolic bone medicine and trustee for the Royal Osteoporosis Society, says men and women start out with similar bones and hit peak bone mass in their 30s. By then, men’s skeletal size and bone density tends to be greater, a disparity believed to be a result of the hormone surges that come with puberty. So men already have stronger bones when gradual age related decline sets in – and for women, this decline is turbocharged by the menopause. An early menopause is a particular risk factor.
“We tend to think of bones as a coat hanger but actually they are dynamic and active,” says Dr Peel. “Bone turnover occurs all through life, with bone being broken down and filled with new bone. Oestrogen plays an important role in this so during 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
Data over the last 20 years shows a significant drop in our consumption of key nutrients in the UK. According to the Health and Food Supplements Information Service, calcium and folate intake have both fallen by 10 per cent, while intake of vitamin D has declined by more than 20 per cent. Calcium is important for building bone – but a range of nutrients is required to absorb and use it.
Lifestyle
“Bones get stronger when we use them,” says Dr Peel. “The sedentary lifestyle, even working from home and not going outside and getting vitamin D all impact bone health. Research suggests that there’s been a rise in alcohol intake too.” This slows down bone cell turnover, vitamin absorption and the production of oestrogen and testosterone, all of which are crucial for strong bones.
Smoking also reduces the production of new bone, and research has indicated a rise in smoking amongst middle-class women.
Other health conditions and medications
“A range of health conditions can increase osteoporosis risk, including ones that affect food absorption like Crohn’s or coeliac,” says Dr Peel. “There are also many medications that can impact bone health, like steroids for asthma or arthritis.”
Family history
Genetics plays a part too. Having a parent who has suffered a hip fracture is a significant risk factor.
How can you get assessed?
There are excellent treatments to slow the rate that bones break down, speed up the process of bone renewal and reduce the risk of further fractures by between 50 and 90 per cent. However, systems to identify the people who need them are patchy and postcode dependent. Health and Social Care Secretary Wes Streeting has promised to remedy this with a national roll out of “fracture liaison services”. He said that it would be one of his first acts in post, but five months into power, nothing has emerged.
Most experts are calling for targeted assessment, where people most at risk are invited to have bone density measured by a dual energy X-ray absorptiometry (Dexa) scan which assigns a T-score, where above -1 is healthy and below -2.5 is considered to be osteoporosis. In the meantime, it’s possible to understand your own risk through the Royal Osteoporosis Society’s risk checker. Anyone who believes they could be at high risk should speak to their GP about a Dexa scan, or at least, a risk-assessment such as the Frax tool which looks at a very wide range of factors to give the 10-year probability of an osteoporosis fracture.
