World Osteoporosis Day 20th October 2026
My piece submitted for World Osteoporosis Day.
My Osteoporosis Was Silent. My Records Were Not.
World Osteoporosis Day encourages us to build, protect and strengthen our bones for life.
But we cannot protect bones when early warnings are overlooked. Nor can we improve osteoporosis care if we allow one scan result to outweigh a patient’s history, fractures and lived experience.
My history of broken bones did not begin in later life. I was three years old. Each fracture had some form of trauma attached to it. There had been a fall, an accident or an injury, so the trauma was accepted as the explanation.
Nobody stepped back and asked whether there might also be an underlying reason why my bones broke so easily. But I asked. I asked time and time again why my bones appeared to fracture more easily than other people’s. I was never given an answer. An accident may explain how a fracture happened. It does not always explain why the bone was unable to withstand it.
At twenty-six, I began receiving the Depo-Provera contraceptive injection. I continued using it until I was fifty-two. Depo-Provera is associated with a reduction in bone mineral density during use. That does not prove it caused my osteoporosis, but it was part of my medical history that should eventually have been considered alongside my fractures and scan results.
At thirty-five, I developed severe, debilitating pain in my upper back following minimal trauma. For four years, that pain was not properly investigated. I was told it was muscular. Then I was told it came from my ligaments and tendons. I was told the size of my breasts was causing the pain and that I needed a breast reduction. My weight was blamed, and I was advised to diet. Eventually, my mental health was questioned.
I kept saying, “It is bone.” The more I insisted that something was physically wrong, the more I felt as though I was being treated as if the problem was in my head. My ex-partner offered little support. His response to illness was blunt: “I don’t do illness.”
With doctors questioning my mental health and the person closest to me unwilling to engage with what I was experiencing, I became increasingly isolated. But the problem was never in my head. Throughout those four years, nobody arranged even basic imaging to see whether there was damage to my spine.
As the pain continued, I began receiving steroid injections into my back and directly into my spine. Every procedure was carried out as a day patient in theatre. I was going into theatre regularly, but the pain did not go away.
Eventually, I insisted on a second opinion outside the area from a consultant who had never met me and had not already formed an opinion about my pain. I made it clear that if I was not referred, I would seek a private opinion myself.
The consultant assured me that he would find the cause. He arranged blood tests, routine screening, a lumbar puncture and an MRI scan. Within hours of the MRI, I finally had my answer. It showed a compression wedge fracture of my T5 vertebra.
For four years, I had been living with severe pain and continuing to do a manual job with a fractured vertebra. By the time the MRI revealed the answer, I had already been put through a lumbar puncture. The problem was not that there had been nothing to find. The problem was that nobody had looked at my spine.
A compression fracture in a woman who had been only thirty-five when the pain began should have raised serious questions about why a vertebra had fractured following such minimal trauma. When I was forty, a DXA scan, sometimes called a DEXA, raised another clear warning. It showed that my bone density was bordering on osteoporosis.
But that result was never disclosed or explained to me. I was told about the compression fracture, but I was not told that the scan had also shown bone density close to the osteoporosis threshold. The result was not properly investigated, and I was not given the information I needed to understand the risk to my bones.
Had I known, I could have asked questions. I could have sought specialist advice. My fracture history, medication and future risk could have been reviewed. By forty, my records contained a lifelong history of fractures, prolonged use of Depo-Provera, repeated steroid procedures, a T5 compression fracture following minimal trauma and a DEXA result bordering on osteoporosis.
These warnings should have been considered together. They were not. I cannot prove that Depo-Provera or the steroid injections caused the severe osteoporosis I live with today, and I am not claiming that they did. Osteoporosis can develop through a combination of different factors.
My point is simpler, and much harder to dismiss. Once a vertebral compression fracture and low bone density had been identified, my medication, repeated steroid procedures and fracture history should have prompted a careful review of the risks, possible alternatives, monitoring and whether my bones required protection.
Years later, osteoporosis revealed itself in the cruellest possible way. I have fractured ten vertebrae and my pelvis. I spent four and a half months unable to sit upright. I have lost approximately ten centimetres in height and live with the permanent consequences of spinal collapse, pain and physical limitation.
Yet when I was approaching sixty, a later DEXA result suggested that the bone density in my spine was around 110 per cent of what would be expected for someone my age. On paper, that sounded reassuring. My body told a very different story.
It was not until I was being considered for spinal surgery that an orthopaedic surgeon became the first person to challenge the results and look beyond the number. He looked at my MRI scan and saw the distorted structure of my spine, the vertebral collapses and the sheer volume of fractures. He said plainly: “Those figures are rubbish. I am sending you for a QCT scan. You have severe osteoporosis.”
He explained that the collapses and new bone forming as the fractures healed had distorted the apparent density.
The compressed and healing areas appeared denser, making the DEXA figures look far more reassuring than the true condition of my bones. The quantitative CT scan, known as a QCT, produced a T-score of minus 3.67 and revealed the severity of the weakness within my vertebral bone.
DEXA is the standard and preferred method used to diagnose osteoporosis. I am not arguing against it. But it is not the only recognised method of assessing bone density. DEXA provides a two-dimensional measurement. QCT measures bone density in three dimensions and can assess the trabecular bone inside the vertebrae separately from the denser outer bone.
No ordinary clinical scan measures every aspect of bone quality. However, vertebral fractures, spinal collapse, osteoarthritis and degenerative changes can interfere with the interpretation of a lumbar spine DEXA result and make it appear more reassuring than the true condition of the bones. A seemingly reassuring number should never be allowed to outweigh ten fractured vertebrae, significant height loss and a life transformed by skeletal damage.
When a scan result and a patient’s history tell different stories, the patient should not be dismissed. The discrepancy should be investigated. Why did a vertebral compression fracture following minimal trauma at thirty-five not trigger a deeper investigation, and why was my lifelong history of fractures not viewed as a pattern?
Why did it take four years and the threat of seeking private care before I was given an independent second opinion? Why was a DEXA scan showing bone density bordering on osteoporosis not disclosed or properly investigated? Why did I continue going into theatre regularly for steroid injections without all these factors being brought together in a full assessment of my bone health? And why did it take an orthopaedic surgeon looking at the damage on my MRI to challenge figures that did not match the condition of my spine?
These are not unreasonable questions. They are questions that may prevent another person from discovering osteoporosis only after their spine has begun to collapse.
World Osteoporosis Day rightly encourages people to take responsibility for their bone health. We are told to eat well, exercise, avoid smoking and understand our risks. I did not smoke or drink. I ate healthily, exercised and was struck down when I was at my fittest.
Responsibility cannot rest entirely with patients. Healthcare professionals must recognise early warnings, disclose and explain significant results, review medicines that may affect the skeleton and look beyond a single number when it does not match the person sitting in front of them.
They must also listen when patients repeatedly say that something is wrong.
It took twenty-nine years from my first vertebral fracture to receive a diagnosis of severe osteoporosis. I now strongly advocate that patients ask for printed copies of every test and scan result and keep them safely in their own records. Had I never been given my original DEXA report and understood what it showed, I could have questioned it, sought specialist advice and asked why it had not been investigated.
I also believe fracture history and other risk factors should prompt earlier bone-health investigation, regardless of a patient’s age. We should not wait for someone to reach a standard screening age when serious warning signs are already present.
Modern patient-record systems should be capable of identifying possible connections between repeated fractures, medications, scan results and other risk factors. With the technology now available, including artificial intelligence, it should be possible to create systems that make a doctor’s job easier and a patient’s care safer.
This is the shared responsibility of osteoporosis. Patients should understand their risks, ask questions and keep their own records. Healthcare professionals must recognise patterns, disclose results and investigate when the evidence does not make sense.
If my experience prevents even one person from suffering as I have, my pain will not have been in vain.
My osteoporosis was described as a silent disease. But the warnings began long before I was forty.
They were there in the fractures that began when I was three.
They were there when I repeatedly asked why my bones broke so easily.
They were there when I kept saying that the pain in my back felt as though it came from the bone.
They were there in the T5 compression fracture,
the four years it took to discover it,
my medication history
and the DEXA result bordering on osteoporosis.
The evidence was there, and the alarm bells should have been ringing.
But I was not even given all the information I needed to understand the danger for myself.
My osteoporosis may have been silent.
But my body was speaking - my records were warning - and I was asking to be heard.
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