Many fractures are early warning signs of osteoporosis. However, a new Austrian national survey by the Complexity Science Hub (CSH) and the Ludwig Boltzmann Institute for Osteology (LBI Osteology) shows that in routine clinical care, they are often not recognized as red flags or documented. Men are more often affected.
Osteoporosis, a disease in which bones lose density and stability, is one of the most common conditions that occur in older adults and significantly increases the risk of fractures. However, it is often diagnosed only after the first typical “osteoporotic fracture”, such as a femoral neck fracture.
New research from Complexity Science Hub and LBI Osteology published in journal bone This is the first comprehensive national study of how osteoporosis and different types of fractures co-occur in Austrian hospital records. The results show that fractures are usually part of a complex pattern of multiple symptoms and highlight the need for consistent osteoporosis screening at the time of fracture.
multiple causes
Fractures rarely have a single cause. Bone density is only part of the picture. Comorbidities, fall risk, and overall health also play a role.
To better understand these connections, the researchers analyzed hospital data in Austria for more than 1.7 million people aged 50 to 79, extracted from insurance claims from 2003 to 2014. Rather than studying each condition in isolation, the researchers looked at which diagnoses tend to co-occur with osteoporosis and different fracture types.
“Health insurance claims data of this scale allows us to look at osteoporosis and fractures not as separate diagnoses, but as part of a much larger, interconnected pattern of conditions over time, a picture that only systematic, population-wide analyzes can capture,” said CSH postdoctoral researcher Elma Dervick.
In clinical practice, osteoporosis and fractures often occur simultaneously with many other conditions, such as cardiovascular diseases, metabolic disorders, and neurological disorders. ”
Martina Behanova, lead author of the study and senior researcher at LBI Osteology
Roland Kosijan, Head of the Department of Osteology and Rare Bone Diseases at Hanusz Hospital Vienna, added: “To reduce the risk of further fractures, we recommend considering the patient’s overall health status. Our study results highlight the importance of a thorough assessment of osteoporosis after a fracture to prevent further fractures.”
Diagnosis is uneven depending on the type of fracture
The study also found that osteoporosis was not systematically recorded for many fracture types. These fractures often indicate underlying bone weakness, even though in some cases they are already classified as classic fragility fractures. Differences between fracture types were particularly striking, with proximal femur fractures most often having a documented diagnosis of osteoporosis, especially in women over 60 years of age.
However, other fractures, particularly those of the forearm, humerus, and pelvis, are still not consistently recognized as signs of osteoporosis in clinical practice. However, they already meet established criteria for an osteoporosis diagnosis, requiring prompt evaluation and initiation of targeted osteoporosis treatment to prevent further fractures.
What is particularly worrying is that fractures do not occur in isolation, but are often closely associated with fractures in other parts of the skeleton. “Therefore, all fragility fractures should be seen as a warning sign that the fracture sequence needs to be interrupted at an early stage,” says Koszyan.
However, it should be noted that this study only included hospitalized patients. Fractures treated on an outpatient basis (common for these types of fractures) could not be included.
Diagnosis gap for men
The study also revealed significant differences between women and men. Osteoporosis in women is often recorded in parallel with various chronic diseases, such as osteoarthritis, whereas in men it is often diagnosed only after a fracture has already occurred.
Of note, osteoporosis was diagnosed or recorded in association with fractures much less frequently in men and in patients aged 50 to 69 years. At the same time, men in this age group were more likely to have injuries and alcohol-related comorbidities.
“Osteoporosis in men may be diagnosed too late,” Delvich says. “This means we are missing an important opportunity to intervene early and prevent further fractures. Early diagnosis can be critical to protecting long-term bone health.”
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Reference magazines:
Bekhanova, M. others. (2026). Gender- and age-specific comorbidity networks associated with osteoporosis and fragility fractures in national data. bone. DOI: 10.1016/j.bone.2026.118014. https://www.sciencedirect.com/science/article/abs/pii/S8756328226002401?via%3Dihub
