Importance of paying attention to bone health in midlife highlighted

By Melanie Hinze

Women’s fracture risk begins to rise from age 35 years and accelerates from the mid-40s, overtaking that of men by about 45 years of age, whereas men’s fracture rates peak in early midlife before gradually declining, according to new research.

The study, published in the Journal of Bone and Mineral Research, drew on UK Biobank data, combining data on self-reported fractures from the 2006 to 2010 baseline assessment with linked Hospital Episode Statistics (HES) data from 2001 to 2022, in adults aged 35 to 65 years.

Of 424,985 eligible participants, women self-reported 196 fractures per 10,000 per year and men 181 per 10,000 per year. Women’s fracture incidence rose steadily through midlife, peaking at 246 per 10,000 per year in the 56- to 65-year age group. In men, the highest incidence (232 per 10,000 per year) was in those aged 35 to 45 years, with women’s rates overtaking men’s from age 46 years onwards.

The most common fracture sites, regardless of sex or age band, were ‘other’ fractures (predominantly digits and the face), followed by wrist, ankle, arm, leg, spine and hip.

About 70% of women reported that their fracture had resulted from a fall from standing height or lower, regardless of age. Among men, 45 to 66% of fractures were fall-related, with the proportion rising in older age groups.

The HES data identified 43,572 fractures, with patterns mirroring the self-reported findings. A validation analysis found that 287 of 364 HES-recorded hip fractures had also been self-reported, supporting the reliability of the self-report data.

Commenting on the study findings, Dr Shoshana  Sztal-Mazer, Endocrinologist and Clinical Lead of the Osteoporosis and Metabolic Bone Service, Department of Endocrinology and Diabetes, Alfred Health, Melbourne, told Medicine Today the study was well conducted, with solid methods and robust analysis.

‘The main limitation in generalising it to an Australian audience is that it was done in the UK and studied a mainly white, higher socioeconomic status population,’ she said. ‘Nevertheless, the main findings are consistent with Australian data such as the Geelong Osteoporosis Study, the Western Australia Population Based Cohort Study and Healthy Bones Australia Reports.’

Dr Sztal-Mazer said the key message for GPs was that, in addition to the older people, there is a fracture burden in midlife that starts as young as 35 years, with most fractures  in women in this age group attributable to falls from standing height or lower, suggestive of bone fragility (excluding fractures in ‘other’ sites).

‘These individuals may be at risk of future fractures given the fracture cascade: the understanding that the biggest risk for a fracture is a previous fracture,’ she said.

She said middle-aged people sustaining minimal trauma fractures at sites other than the hands, face and feet warranted a work-up for osteoporosis, along with attention to modifiable risk factors such as adequate intake of dietary calcium and protein, vitamin D sufficiency, weight-bearing exercise, nonsmoking and minimising alcohol intake.  In some, pharmacotherapy could be considered depending on the fracture site, cause and dual-energy x-ray absorptiometry result.

She added that falls prevention was important in all patients but especially in women after 45 years of age.

J Bone Miner Res 2026; 00: 1-9. https://doi.org/10.1093/jbmr/zjag046.