30 years of World Osteoporosis Day: making the first fracture the last

One in three women and one in five men over the age of 50 are likely to break a bone because of osteoporosis. October 20th marks 30 years of World Osteoporosis Day. The last 30 years have seen advancements in pharmaceuticals, imaging and the development of dedicated Fracture Liaison Services (FLS).

This year's World Osteoporosis Day theme is "Build, Protect and Strengthen Your Bones for Life", and the last part of that, strengthening bone health after a fracture to prevent the next one, is exactly what FLS do.

For many people, osteoporosis goes undiagnosed until they break a bone, whether that's a wrist after a trip on the pavement or a vertebra that cracks with little more than a bend or a cough. Having one fragility fracture makes another much more likely, so that moment of diagnosis is one of the best chances the NHS has to prevent the next one.

At Ufonia, we've been working with NHS FLS clinicians to explore how Dora, our AI voice assistant, could take on some of the routine phone conversations that FLS teams have with every patient, from the first assessment through to follow-up.

A gap in care we know how to close

Around 3.5 million people in the UK live with osteoporosis, and there are roughly 500,000 fragility fractures every year, with numbers projected to grow as the population ages.

FLS specialist teams identify patients, assess their risk of further fractures, start bone-protecting treatment, and follow up to check it is working. FLS are a well-established model for catching people after that first fracture.

Demand is outpacing capacity

In England, FLS teams identified around 79,500 patients in 2025, but the Royal Osteoporosis Society estimates around 264,000 people a year need to be reached. Around half of NHS trusts have no FLS at all, and the latest national data suggests services reach only about 37% of eligible patients.

The Government has pledged nationwide FLS coverage in England by 2030. At the current pace, the Royal Osteoporosis Society warns that goal may not be met until 2064. Closing the gap is not only about new services: it depends on specialist nurses, clinicians and radiographers who are already in short supply. Every patient needs an assessment, then follow-up over months and years, and much of that work happens by phone.

Starting treatment is only half the job

Bone-protecting medication works, but only if people keep taking it, usually for three to five years. Studies suggest around half of patients have stopped within a year. This could be because of side effects, uncertainty about how to take it, or simply not feeling any different.

Follow-up calls at 16 weeks and 12 months are meant to catch this by checking treatment has started, asking about side effects and checking for new falls or fractures, but capacity makes this hard in practice. In the most recent national audit for England and Wales, only 28% of FLS patients had a documented follow-up within 16 weeks, and just 12% were recorded as still taking their medication at 12 months. Many of those patients may be doing fine, but without a conversation, nobody knows.

What a Dora FLS conversation looks like

Dora, Ufonia's AI voice assistant, holds structured clinical telephone conversations with patients and then sends a summary back to the clinical team for review and a decision about what care the patient will need.

Working with FLS clinicians, we've designed two sets of conversations that mirror the calls teams already make:

• The first assessment: Dora asks about the things that shape a person's future fracture risk, such as smoking, alcohol and whether a parent has broken a hip.
• The 16 week and 12 month follow-up: Dora checks in on bone-protecting medication, asks about common side effects, and asks whether the person has had any new falls or fractures.

The aim is to handle the routine, structured parts of these calls and hand clinicians a clear summary, so they can spend more of their time where their expertise matters most.

Dora's FLS conversations were designed with NHS FLS clinicians and are currently being evaluated in a clinical study with NHS partners, and we'll share what we learn once it is complete.

To find out more about our work in this area, get in touch.

Every fracture is a chance to act

Reaching every patient who needs FLS care will take more clinicians, better data and new ways of working. We think well-evaluated conversational AI could be part of that, and we're committed to building the evidence carefully and in the open.

Thank you to the FLS teams and patients who have helped shape this work, and to Innovate UK for funding it.

This World Osteoporosis Day, if you're over 50 and have broken a bone from a simple fall, ask your GP whether you should be checked for osteoporosis. The Royal Osteoporosis Society and the International Osteoporosis Foundation have more information and support.

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Sources

• World Osteoporosis Day 2026, International Osteoporosis Foundation
• England flatlining on osteoporosis care, Royal Osteoporosis Society (3 July 2026)
• FLS-DB annual report 2025, Royal College of Physicians
• Fracture liaison services: towards universal coverage in England by 2030, House of Lords Library (30 September 2025)
• Lems W, Javaid K. Monitoring in FLS, International Osteoporosis Foundation
• Fatoye F, et al. Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review, BMJ Open (2019)