30/07/2026
The 2026 NICE Osteoporosis Update: Don’t Wait for the First Fracture
Osteoporosis is often called the “silent disease” because bones become weaker without causing symptoms until a fracture occurs. The good news is that many fractures can be prevented with timely risk assessment and appropriate treatment.
What has the 2026 NICE guidance reinforced?
Assess fracture risk, not just bone density.
Use validated tools such as FRAX® (or QFracture) to estimate a person’s 10-year risk of major osteoporotic and hip fractures. Bone mineral density (DEXA) adds value but should always be interpreted alongside clinical risk factors not in isolation.
Who should be assessed?
Consider fracture risk assessment in:
• Adults aged 50 years or older with a previous fragility fracture
• Anyone taking long-term oral glucocorticoids
• Women aged 65 years or older and men aged 75 years or older
• Younger postmenopausal women or adults aged 50–74 years with risk factors such as low BMI, smoking, frequent falls, a family history of hip fracture, excess alcohol intake, or medical conditions and medications associated with bone loss
Who should receive treatment?
Treatment should be considered for people with:
• A previous hip or vertebral fracture
• Osteoporosis on DEXA (T-score ≤ –2.5)
• Osteopenia with additional high-risk features
• Very high-dose glucocorticoid exposure
One important message
A normal DEXA scan does not always mean low fracture risk, and a low T-score alone should not determine treatment. Age, previous fractures, falls risk, medications, and the overall clinical picture remain essential when making decisions.
Early identification, resistance exercise, adequate calcium and vitamin D (when indicated), fall prevention, and appropriate medication can significantly reduce the risk of future fractures.
Strong bones are built over a lifetime. Preventing the first fracture is always better than treating the next one.