When someone breaks a bone from a minor fall or bump, the immediate focus is always on treating the fracture itself: getting the bone to heal, managing pain, recovering function. That's understandable. But the fracture is often a signal of something deeper, and what happens in the weeks and months after determines whether it's a single event or the beginning of a pattern.
In Australia, the numbers are striking. Over 193,000 osteoporotic fractures occur every year. That's one every 2.7 minutes. The total cost exceeds $3.5 billion annually. And yet, fewer than 20% of people who fracture are ever investigated or treated for the underlying bone disease. That gap is one of the biggest missed opportunities in preventive medicine.
The repeat fracture cascade
A fragility fracture is not just an injury. It's a marker of bone fragility, and it roughly doubles your risk of having another one. The risk is highest in the period immediately after the first fracture, which is why the term "imminent fracture risk" has become a focus in the guidelines.
A large meta-analysis found that 7.6% of people who have a fragility fracture will fracture again within the first year. By two years, that figure rises to 11.6%. Nearly half of all repeat fractures occur within the first two years. The window of highest risk is also the window where treatment has the greatest potential to help.
The pattern is even more pronounced with spinal fractures. Women who have had a vertebral fracture are over four times more likely to sustain another fracture within the next year. People who have had two or more fractures are up to nine times more likely to fracture again. This cascading effect is why early intervention is so important.
The mortality side
Fractures aren't just about pain and disability. Australian data from the Dubbo Osteoporosis Epidemiology Study found that the five-year mortality after a fracture was 51% in men and 39% in women. If a second fracture occurred, mortality rose to 75% for men and 50% for women. These are numbers that should change the way we think about a "simple" broken bone.
Why so many people fall through the gaps
The disconnect between fracture and follow-up is one of the most frustrating problems in Australian healthcare. Australian research from the 45 and Up Study found that after a fracture, only 17% of high-risk women and 7% of high-risk men received a referral for a DXA bone density scan. Only 22% of women and 14% of men were started on osteoporosis medication.
There are several reasons this gap exists. Fracture care in hospital and emergency departments is focused on treating the acute injury: setting the bone, managing pain, planning rehabilitation. The question of why the bone broke often gets deferred. The assumption is that the GP will follow up, but the communication doesn't always happen, and the patient may not realise there's anything more to investigate.
On the patient side, there's a common pattern of attributing the fracture to the fall rather than to the bone. "I slipped on the rug" explains the event, but it doesn't explain why that particular fall broke a bone when a similar fall at age 30 wouldn't have. The fracture is the signal. The fall is just the trigger.
A patient comes in months or even years after a wrist fracture, a rib fracture, or a compression fracture in the spine. They were treated at the time, the bone healed, and nobody mentioned osteoporosis. By the time we test, the bone density is significantly low, and the opportunity for early treatment has been missed. If you've had a fracture from a minor fall and weren't investigated afterwards, it's worth raising with your GP. It's never too late to start.
What should actually happen after a fracture
The 2024 RACGP/Healthy Bones Australia guideline is clear about what post-fracture care should look like. The process can be summarised in three steps: identify, investigate, intervene.
Step 1: Identify the fracture as a fragility fracture
A fragility fracture is one that results from a force that wouldn't normally break a healthy bone: a fall from standing height or less, a minor bump, or sometimes no obvious trauma at all (as is often the case with vertebral fractures). If you're over 50 and you've broken a bone from something that doesn't seem like it should have caused a fracture, it should be investigated.
Step 2: Investigate
Your GP should arrange a DXA bone density scan (if you haven't already had one) and blood tests to screen for secondary causes of bone loss. The standard workup includes calcium, vitamin D, thyroid function, kidney function, and a few other tests depending on your situation. In men, testosterone may be checked. If there's any concern about a blood disorder contributing to bone loss, additional tests can be arranged.
For hip and vertebral fractures, the guideline notes that treatment can be started even without a DXA result, because the fracture itself is sufficient evidence of significant bone disease. Waiting for a scan should not delay treatment in these cases.
Step 3: Intervene
Intervention means building a plan that addresses the full picture. That typically includes medication (if the fracture risk warrants it), calcium and vitamin D optimisation, exercise (specifically resistance training and balance work), falls prevention measures, and regular follow-up.
| Action | Purpose |
|---|---|
| DXA bone density scan | Measure current bone density and guide treatment decisions |
| Blood tests | Screen for secondary causes of bone loss (calcium, vitamin D, thyroid, kidney function, others as indicated) |
| Falls risk assessment | Identify modifiable falls risk factors (balance, vision, medications, home hazards) |
| Fracture risk calculation | FRAX or Garvan tool to estimate 10-year fracture probability |
| Medication review | Start osteoporosis treatment if indicated; review medications that increase falls risk |
| Exercise referral | Physiotherapist or exercise physiologist for bone-loading and balance program |
| Calcium and vitamin D | Optimise dietary calcium; supplement vitamin D if deficient |
| Ongoing monitoring | Follow-up DXA, medication adherence, repeat falls assessment |
Why timing matters
A study of patients who received treatment during their hospital stay for a hip fracture found that starting treatment early reduced subsequent vertebral fractures by 60% and overall mortality by 38% over two years. Treatment benefit for preventing further fractures begins to emerge within approximately 12 months. The sooner treatment starts after a fracture, the sooner it begins to protect.
How to reduce your risk of another fracture
If you've already had a fragility fracture, there are several things that can significantly reduce your risk of having another one.
Medication
For people with osteoporosis and a history of fracture, medication is one of the most effective interventions. Depending on the medication, they can reduce the risk of vertebral fractures by 40 to 70% and hip fractures by 20 to 40%. Several types of medication are available in Australia, and your GP or specialist can help determine which is most appropriate for your situation.
If you're already on treatment, the most important thing is to stay on it. Medication adherence is one of the biggest challenges in osteoporosis management. Many people stop treatment because they feel fine, question whether they still need it, or worry about side effects they've read about. In the vast majority of cases, the benefit of continuing treatment far outweighs the risk of stopping.
Exercise
Resistance training and balance exercises reduce both falls and fractures. Exercise programs have been shown to reduce falls by 23% and may reduce fall-related fractures. An exercise physiologist or physiotherapist with experience in bone health can design a program that's safe and effective for your current level of function.
Falls prevention
Over 90% of hip fractures result from a fall. Reducing your falls risk is just as important as strengthening your bones. This includes reviewing medications that affect balance (sedatives, blood pressure medications, certain antidepressants), checking your vision, making your home safer (removing loose rugs, improving lighting, installing grab rails in the bathroom), and doing regular balance exercises.
Nutrition
Adequate calcium (1,000 to 1,300mg per day depending on age and sex) and vitamin D (at least 50 nmol/L in the blood) are necessary for osteoporosis medication to work properly. They're foundations, not treatments on their own. Protein intake also matters: 1.0 to 1.2g per kilogram of body weight per day is recommended for older adults.
Want the whole series on one page? I've put every bone-health habit, graded by the evidence, into a free one-page shortlist that comes with the newsletter.
The role of your GP
Your GP is often the best person to coordinate post-fracture care, because they can see the whole picture: your bone health, your falls risk, your medications, your overall health, and what's realistic for your situation. They can arrange investigations, start treatment, refer you to allied health professionals, and monitor your progress over time.
If you've had a fracture and it wasn't followed up, it's not too late. The treatment gap exists because the system often doesn't connect the dots automatically. But when the investigation is done and a plan is put in place, the evidence for reducing future fracture risk is strong.
If any of the following apply to you, it's worth booking an appointment to discuss your bone health.
- You've had a fracture from a minor fall and weren't investigated for osteoporosis
- You were diagnosed with osteoporosis but haven't started or have stopped treatment
- You're on osteoporosis medication and want to know if it's working
- You've had more than one fracture
- You have risk factors for osteoporosis and haven't had a bone density scan
- You're concerned about your falls risk
A first fracture doesn't have to lead to a second one. With the right investigation and a clear plan, the cascade can be interrupted. That's the conversation I'd encourage you to have with your GP.
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Common questions about post-fracture care
Clinical information in this article is informed by the 2024 RACGP/Healthy Bones Australia guideline for osteoporosis management and fracture prevention, the Dubbo Osteoporosis Epidemiology Study (Bliuc et al., JAMA 2009), Wong et al. 2022 (Osteoporosis International), Bliuc et al. 2023 (PLoS Medicine), Fan et al. 2024 (JBMR), and the Healthy Bones Australia Burden of Disease Report 2024. This is general information only. Your GP can advise on what's relevant for your individual situation.
