Mid West study finds people are reaching older age with healthier bones

A major study conducted in the Mid West region, spanning more than a quarter of a century, has found a striking decline in osteoporosis among people undergoing their first bone-density assessments.

The research, published in the ‘Archives of Osteoporosis’ journal, analysed 66,681 people undergoing their first DEXA - or bone-density - scan at University Hospital Limerick and St Camillus Hospital between January 1998 and December 2024.

Researchers examining more than 66,000 patients in Limerick, Clare and Tipperary found that the proportion with osteoporosis at the hip fell from approximately 19 per cent in 1998 to 7 per cent in 2024. At the lumbar spine, prevalence fell even more markedly, from approximately 30 per cent to 8 per cent.

The findings now raise the possibility that future generations of older people may face a substantially different burden of bone disease than previously expected.

The research team, who are based at University Hospital Limerick and St Camillus’ Hospital, believe the findings could have important implications for how Ireland anticipates the healthcare needs of a rapidly ageing population. Osteoporosis weakens bones and is an important contributor to fragility fractures, particularly fractures of the hip and spine, which can result in disability, loss of independence and substantial demands on health and social-care services.

Dr Azrin Muslim, Research Directorate at St Camillus Hospital in Limerick, commented:

“The results do not mean osteoporosis has ceased to be a significant health problem, nor do they show that fractures will necessarily decline at the same rate. Hip-fracture risk, for example, is influenced not only by bone strength but also by falls and other clinical factors. While further research will be needed to establish whether similar trends are occurring nationally and internationally - and whether improvements in bone density translate into lower fracture rates - the scale and duration of the Irish dataset provide evidence that the health profile associated with older age may itself be changing.”

“For policymakers, that could mean future healthcare planning needs to consider not just how many people will live into old age, but how healthy those people are likely to be when they get there.”

The research suggests that people presenting for assessment today may, at a given age, have significantly healthier bones than their counterparts did a generation ago.

Professor Declan Lyons, one of the study’s authors and HSE Director of Research in Limerick, believes the results call for a reassessment of some assumptions about ageing and future disease.

“This study has significant implications for our understanding of current ageing patterns and challenges our current understanding of the diseases that will afflict us in later life. Osteoporosis and fractures of the hips and spine may not be as big a part of the future mix as we thought. The paper also reminds us that while growing old is inevitable, ageing isn’t and can be managed,” said Prof. Lyons.

“The findings also raise a broader question about projections of ill health in an ageing population. Forecasts based primarily on historical rates of age-related disease can assume that a person reaching 70, 80 or 90 in the future will have broadly the same underlying risk as somebody of that age in previous generations. This data suggests that assumption may not always hold true,” Prof. Lyons added.

The work done by the research team proves that the downward trend could not be explained by changes in the age or sex of those being scanned. After adjusting for both factors, each successive calendar year was associated with a 4 per cent reduction in the odds of osteoporosis at the hip and a 4.9 per cent reduction at the lumbar spine. Across the study period, this amounted to an approximately two-thirds reduction in the prevalence of osteoporosis among people presenting for their first scan.

Sandra Broderick, Regional Executive Officer, HSE Mid West, added: “This is an encouraging finding, not only because it points to healthier bones among people reaching older age, but because it challenges us to think differently about what ageing will look like for future generations. For health services, understanding how the health of an ageing population is changing is just as important as understanding how many people will need care. Research of this scale, carried out over more than two decades in the Mid West, gives us valuable evidence to inform that thinking.”

The researchers used only the first recorded DEXA scan for each individual, reducing the potential distortion that could arise from repeatedly scanning patients already receiving osteoporosis treatment or undergoing clinical surveillance. Osteoporosis was defined using internationally recognised bone-density criteria at the total hip or lumbar spine.

The findings remained consistent when the researchers standardised the results for age and accounted for changes in the number of scans being performed over the 26-year period.

The researchers say a number of developments over recent decades could potentially be relevant to changing bone health, including greater awareness of osteoporosis, vitamin D supplementation and increased emphasis on fracture prevention. However, the observational study was designed to establish the long-term trend rather than determine its cause.