A fragility fracture occurs every 10 minutes in France, silently reshaping lives and challenging healthcare systems.
Imagine a world where a simple cough, a sneeze, or stepping off a curb could result in a broken bone. For millions of older adults in France, this is not imagination but reality. These are fragility fractures—bone breaks that occur from forces that should not normally cause injury, like a fall from standing height or less.
Often stemming from osteoporosis, a condition that silently weakens bones over time, these fractures represent a major public health crisis that disproportionately affects France's aging population. By delving into the latest French research, we can uncover the true scale of this silent epidemic and explore the innovative approaches being used to combat it.
Fragility fractures occur in France
Women over 50 experience osteoporosis fractures
Men over 50 experience osteoporosis fractures
Fragility fractures are not your typical broken bones from significant trauma. The World Health Organization defines them as fractures resulting from low-energy trauma, such as a fall from a standing height or less 5 . They serve as critical warning signs of compromised bone strength, often pointing to underlying osteoporosis.
Can cause height loss, chronic pain, and kyphosis (dowager's hump)
Most serious with high mortality and loss of independence
Often the first sign of osteoporosis in postmenopausal women
Common in falls onto an outstretched hand
Increasingly recognized as a significant fragility fracture site
France, like many developed nations, has an aging population, which directly correlates with increasing fragility fracture rates. As the population over age 65 grows, so does the number of people at risk.
Chart: Aging Population Projection in France
Research indicates that women are disproportionately affected, with approximately 1 in 3 women over 50 experiencing osteoporosis fractures globally, compared to 1 in 5 men 8 . This gender disparity is largely attributed to the rapid bone loss that women experience after menopause due to declining estrogen levels.
"A hip fracture can be life-altering, with 10-20% of previously independent patients requiring long-term nursing care, and 40% unable to walk independently after one year."
Beyond the human cost, fragility fractures place a substantial financial burden on healthcare systems. Across Europe, the costs are staggering—totaling billions of euros annually—and are predicted to rise dramatically as populations continue to age 8 .
Until recently, assessing the true burden of osteoporosis and fragility fractures in France faced significant challenges. Each data source provided only part of the picture—healthcare claims missed undiagnosed cases, while self-reported surveys lacked medical verification.
In 2025, a groundbreaking study published in Archives of Osteoporosis introduced an innovative approach to this problem by linking two complementary data sources 1 7 :
The research team linked data from 5,039 participants aged 25 years and older, creating a unique dataset that could cross-reference self-reported conditions with actual medical diagnoses and treatments recorded in the healthcare system 1 7 .
The study employed sophisticated statistical methods, including capture-recapture analysis (traditionally used in ecology to estimate animal populations) to provide more accurate prevalence estimates than either source could offer alone.
The linked data analysis revealed striking insights about osteoporosis and fragility fractures in France:
| Data Source | Prevalence Estimate | Population Represented |
|---|---|---|
| Self-reported (Survey) | 4.1% | People aware of their diagnosis |
| Treated (Claims) | 2.2% | Those receiving medication |
| Capture-Recapture | 7.6% | Total estimated population |
Table 1: Osteoporosis Prevalence in France Through Different Data Sources
The capture-recapture method estimated the true prevalence of osteoporosis at 7.6%—significantly higher than either self-reported (4.1%) or treated (2.2%) rates alone would suggest 1 7 . This indicates a substantial number of people living with undiagnosed or untreated osteoporosis.
The research also identified clear disparities in osteoporosis identification. People with lower education levels, limitations in daily activities, and multiple chronic conditions were more likely to have osteoporosis that was captured in only one data source, suggesting disparities in diagnosis and treatment 1 7 .
Perhaps most importantly, the study found that healthcare claims indicators were better predictors of future fractures than self-reported osteoporosis, highlighting the value of this data for identifying high-risk individuals 1 7 .
| Key Risk Factors for Fragility Fractures | |
|---|---|
Modifiable Factors
|
Non-Modifiable Factors
|
Table 2: Key Risk Factors for Fragility Fractures
Chart: Osteoporosis Prevalence by Data Source
The impact of a fragility fracture extends far beyond the initial broken bone. Research consistently shows that suffering one fragility fracture dramatically increases the risk of subsequent fractures—in some studies, doubling the risk of another break 2 .
This creates a vicious cycle known as the "fracture cascade," where each successive fracture further diminishes bone health and functional capacity.
First fragility fracture occurs, often at wrist or spine
Risk of subsequent fractures doubles
Multiple fractures occur in rapid succession
Loss of mobility, independence, and quality of life
The good news is that fragility fractures are largely preventable with appropriate interventions. The 2025 French study demonstrated that coupling different data sources allows healthcare systems to better identify treatment and knowledge gaps, enabling more targeted prevention strategies 1 7 .
of fragility fracture patients receive anti-resorptive treatment within one year
reduction in subsequent fracture risk with appropriate treatment
Internationally, research from Sweden's STORM study cohort has shown that while only about 10% of fragility fracture patients receive anti-resorptive treatment within one year after their fracture, those who do receive treatment experience significantly better outcomes, including reduced risk of subsequent fractures and lower mortality .
| Research Tool | Primary Function | Application in French Study |
|---|---|---|
| Healthcare Claims Databases | Track diagnosed conditions, treatments, and healthcare utilization | Identified diagnosed osteoporosis, treatments, and clinical fractures in SNDS |
| Health Interview Surveys | Collect self-reported health status and conditions | Captured self-reported osteoporosis in ESPS survey |
| Data Linkage Systems | Connect different data sources for individual patients | Linked SNDS and ESPS data using unique national identifiers |
| Capture-Recapture Analysis | Estimate total population prevalence using multiple data sources | Calculated true osteoporosis prevalence (7.6%) beyond what either source showed alone |
| Fracture Risk Assessment Tool (FRAX®) | Calculate 10-year probability of major osteoporotic fractures | Used globally to identify high-risk patients needing intervention |
Table 3: Essential Tools in Fragility Fracture Research
Combining multiple data sources provides a more complete picture of osteoporosis burden and treatment gaps.
Advanced statistical models help identify high-risk individuals before they experience fractures.
Large-scale data enables public health approaches to fracture prevention across populations.
The innovative French research highlights a crucial insight: no single data source can fully capture the osteoporosis burden. Instead, coupling healthcare claims with survey data provides the comprehensive view needed to develop effective public health strategies 1 7 .
This approach aligns with international efforts, such as the recent Spanish-led consensus that brought together 300 professionals and 31 scientific societies to develop ten core recommendations for fragility fracture prevention. These recommendations include implementing Fracture Liaison Services, promoting fracture registries, and increasing public awareness 4 .
The WHO has also recognized the urgency of this issue, launching the Bone Health and Ageing Initiative in 2023 to develop a strategic roadmap for optimizing bone health in older populations 5 .
Chart: Projected Impact of Prevention Strategies
As research continues to illuminate the true scale of fragility fractures in France and beyond, the hope is that more integrated approaches to prevention, diagnosis, and treatment will help turn the tide on this silent epidemic—ensuring that later years are characterized not by fragility, but by continued strength and independence.
Integrated data approaches, targeted interventions, and public awareness can transform bone health for aging populations.