Empowering older women in supported self-management of osteoporosis

Background: Half of women over eighty are estimated to have osteoporosis, contributing to 180,000 fractures annually in the UK, with substantial personal and economic costs, despite clinically effective treatments and national guidelines being available.

This work evolved from speaking with 32 women aged 70+ across five groups about the Women’s Health Strategy for England (2021). These women told us they felt ‘unseen’, ‘unimportant’, ‘unheard’, and ‘uninformed’, and that 55+ was too broad a catchment for ‘older women’ (OW). They also prioritised bone/joint health and osteoporosis.

 

Aim: To use insights from the experiences of OW and primary healthcare practitioners (HCPs) to develop strategies to improve osteoporosis management in primary care.

 

Methods:Data generation

We interviewed 30 community-dwelling OW (aged 70+) diagnosed with osteoporosis (11 from South Asian heritage), and 30 NHS primary HCPs, including GPs, nurses, physiotherapists, and pharmacists. We used a Constructivist Grounded Theory approach to explore knowledge, communication, care pathways, and self-management practices. We reviewed findings with our co-production group comprised OW and HCPs.

 

Stakeholder involvement

A local advocate for the Royal Osteoporosis Society joined us as a co-applicant on the Project Management Group and helped produce the protocol and patient facing materials, and facilitate the ‘open days’.

We held two ‘open days’ for the public. Following these, seven OW and three HCPs joined our co-production group. We held a separate group for three South Asian older women which was conducted in Punjabi. We met from August 2024 to August 2025.

 

Key findings, impact, and outcome

HCPs acknowledged osteoporosis as clinically important, but guidelines were inconsistently applied, and follow-up was erratic due to a lack of standardised care pathways or incentivised monitoring.

OW normalised symptoms as part of ageing, delaying investigations or treatment. Most were unclear about diagnosis, prognosis, or treatment plans. Self-management was accepted but inadequately supported, with information frequently generic or absent. South Asian women experienced additional cultural, linguistic, and logistical barriers.

 

Routine engagement with the wider primary care team was rare, with allied health professionals an underused resource. Digital communication further limited OWs engagement/re-engagement. Older women wanted accessible, reliable information and empathetic support.

OW and HCPs taking part in the study expressed how their involvement made them think about their attitude and actions regarding osteoporosis in future.

We co-produced a set of recommendations for use in primary care and public health promotion.

 

Implications: Worldwide, osteoporosis remains poorly understood and inadequately managed. Ageing demographics are a global challenge, compounded by multi-morbidities. Many OW accept care gaps due to limited awareness and lack of meaningful interaction with HCPs. Those aged 70+ face particular barriers, including multimorbidity, digital exclusion, and low self-efficacy. Cultural and communication differences further shape the care experiences of ethnic minorities.

Improved care navigation and greater involvement of the wider primary care team could enhance engagement and support better self-management.