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Musculoskeletal and Sports Medicine

Substantial Fracture Risk Burden in Midlife Women: Population-Based Evidence for Reconsidering Current Screening Guidelines

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 7

    Primary Author(s)

  • JC

    Joshua Cassinat, MD

    Medical Resident
    University of Central Florida College of Medicine
    Orlando, Florida

    • Co-Author(s)

  • VW

    Vonda Wright, MD

    Attending Physician
    University of Central Florida College of Medicine
    Orlando, Florida

    • Poster Presenter(s)

  • Grace Olson, Other

    Medical Student
    Boston University Chobanian & Avedisian School of Medicine
    Roxbury, Massachusetts

  • Kayleigh Crane, Other (she/her/hers)

    Medical Student
    Central Michigan University College of Medicine
    Mt Pleasant, Michigan

Disclosure(s):
Grace Olson, Other: No financial relationships to disclose
Background and/or Objectives: Current fracture prevention guidelines recommend screening women beginning at age 65, based on assumptions about low fracture risk in midlife. However, comprehensive population-based data reveal that 84.7% of women aged 50-59 with osteoporosis remain undiagnosed under current screening protocols, potentially leading to millions of missed prevention opportunities. This study quantifies the substantial disease burden of fracture risk factors in midlife women (aged 50-64) and provides evidence for reconsidering current screening guidelines.

Design: Cross-sectional analysis of nationally representative data from the Health and Retirement Study (HRS) 2022 and National Health and Nutrition Examination Survey (NHANES) 2001-2023.

Setting : Population-based study within the United States.

Participants : 10,900 women aged 50-64 years from nationally representative datasets.

Interventions: NA

Main Outcome Measures: Prevalence of major fracture risk factors including bone density testing rates, osteoporosis diagnosis, recent falls, and prior hip fractures. Survey-weighted analysis provided population-level estimates with 95% confidence intervals.

Results: Among 10,900 midlife women (mean age 56.8 years), substantial disease burden was evident: 72.3% (95% CI: 68.9%-75.3%) had undergone bone density testing, 41.3% (95% CI: 38.1%-44.7%) reported recent falls, 21.3% (95% CI: 18.5%-24.3%) had been diagnosed with osteoporosis, and 3.0% (95% CI: 2.1%-4.4%) had experienced prior hip fractures. These prevalence rates represent approximately 17 million US women with recent falls and 8.4 million with osteoporosis diagnoses during the midlife period, before current screening guidelines recommend routine assessment.

Conclusions: This analysis reveals substantial fracture risk burden in midlife women that is largely invisible under current screening guidelines focused on women aged 65 and older. Given that over one-fifth of women aged 50-64 have osteoporosis with over 40% reporting recent falls, findings support lowering the starting age for routine DXA screening to at least 50 years. Prospective studies are needed to evaluate the clinical and economic impact of earlier screening.