A pragmatic randomised controlled trial of screening for osteoporosis in older women

Every year, around one in five women over 50 breaks a bone because their skeleton has quietly thinned to the point of failure. Osteoporosis affects roughly 20% of women over 50, but doctors currently have no systematic way to identify who will actually fracture. Existing treatments can cut fracture risk by 35% to 50%, yet without a reliable screening programme, many high-risk women go untreated while others receive drugs they do not need. This trial will test a practical solution: screen every woman aged 70 to 85 for fracture risk, then offer treatment to those flagged as high-risk. Over five years, researchers will compare fracture rates between the screened group and a group receiving usual care. If screening reduces fractures by the hoped-for 20%, the impact would be immediate and concrete. Fewer hip fractures would mean fewer emergency surgeries, fewer hospital stays, and fewer older women losing their ability to live independently. For the NHS, that translates into avoided costs for orthopaedic care, rehabilitation, and social support. For individual women, it means a better chance of staying mobile and in their own homes. The study is a pragmatic trial—it tests whether a simple, scalable screening programme works in real GP practices, not just in a research clinic.