How common are fractures in women aged 50 to 60?

In a New Zealand trial of women aged 50 to 60, 11.1% of the placebo group had a new vertebral fracture on X-ray over 10 years. In WHI, 11.1% of the placebo group aged 50 to 79 had any fracture over about 5.6 years.

Does a previous fracture raise the risk of another?

Yes. A vertebral fracture raises the risk of another vertebral fracture about 5-fold and of other fractures 2- to 3-fold.

Should a woman with osteopenia alone take a bone drug?

Usually not on T-score alone. In FIT, alendronate cut clinical fractures only when the T-score was -2.5 or lower. FRAX should guide the decision in osteopenia.

Does exercise prevent fractures?

Exercise raises BMD a little. A Cochrane review of 43 trials found small BMD gains but could not show fewer fractures. It still helps muscle strength and falls.

Evidence · for healthcare professionals

Fracture risk around menopause and how to reduce it

Dr Aditya Aggarwal, MS (Ortho), PMC 45581, Aggarwal Clinic, Patiala
Last reviewed 18 October 2026 · next review 18 October 2027

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On this page 7 sections

How big is the risk?
What raises risk
What lowers risk: lifestyle
What lowers risk: hormone therapy
What lowers risk: bone drugs
Putting it together: a practical order
Related evidence pages

Evidence summary for clinicians. For discussion, not a prescription. Grades are a GRADE-style reading of the cited sources unless a guideline grade is quoted.

How big is the risk?

Placebo groups of large trials give a guide to baseline risk.

Group (placebo arm)	Fracture outcome	Rate
WHI, women 50-79 with a uterus, about 5.6 years¹	Any fracture	11.1%
New Zealand women aged 50-60, T-score 0 to -2.5, 10 years²	New vertebral fracture on X-ray	11.1%
FREEDOM, women 60-90 with osteoporosis, 3 years³	Vertebral / hip	7.2% / 1.2%
HORIZON, mean age 73 with osteoporosis, 3 years⁴	Vertebral / hip	10.9% / 2.5%

Indian data

Hip fractures in India occur about a decade earlier than in Western women⁵. One hospital study quoted by IMS India found vertebral fractures in about one in five women aged 40 to 49. This is a single-centre figure and should not be taken as population prevalence⁵.

OUTSIDE INDIA In 15,570 Europeans aged 50 to 79, about 12% of women had a vertebral deformity on X-ray, range 6% to 21% by centre (EVOS)⁶. Not Indian data; use as a guide.

NO INDIAN DATA No Indian fracture incidence for perimenopausal women was found.

OUTSIDE INDIA See the WHI any-fracture and New Zealand vertebral-fracture rates in the table above^{1, 2}. Use as a guide.

Evidence grade: Low. No Indian population fracture incidence for perimenopausal women was found.

What raises risk

A previous fragility fracture. A vertebral fracture raises the risk of another about 5-fold and of other fractures 2- to 3-fold⁷.
Low BMD. Each standard deviation fall in BMD roughly doubles fracture risk⁵.
Early menopause or premature ovarian insufficiency⁵.
Medicines. Glucocorticoids, aromatase inhibitors, enzyme-inducing anti-epileptic drugs and others^{5, 8}.
Low body weight. Women with lower BMI lose bone faster through the transition⁹.

What lowers risk: lifestyle

Measure	Key evidence	Effect	Certainty
Resistance and impact training	LIFTMOR RCT, n=101¹⁰	Spine BMD +2.9% vs -1.2%	Low (BMD only)
Any exercise	Cochrane, 43 RCTs¹¹	Small BMD gains; no fracture reduction shown	Low
Calcium	Systematic review¹²	No effect in lowest-bias trials	Low
Vitamin D (not deficient)	VITAL RCT¹³	No fewer fractures (HR 0.98)	Moderate

Lifestyle still matters. It keeps muscles strong and helps prevent falls. It should not delay a drug when risk is high.

What lowers risk: hormone therapy

Trial	Outcome	Result	Absolute effect
WHI oestrogen + progestin^{1, 14}	Hip fracture; all fractures	HR 0.66; 8.6% vs 11.1% (HR 0.76)	5 fewer hip fractures per 10,000 women per year
WHI oestrogen alone¹⁵	Hip; total fractures	HR 0.61; HR 0.70	6 fewer hip fractures per 10,000 women per year
Cochrane 2025¹⁶	Clinical fracture (combined therapy)	RR 0.78	Moderate certainty

The same WHI arm showed 8 more breast cancers, 8 more strokes, 8 more pulmonary emboli and 7 more heart events per 10,000 women per year¹⁴. Bone benefit is real but small in absolute terms, which is why most guidelines do not use MHT for bone alone in women without symptoms¹⁷. See the HRT article.

Evidence grade: Moderate.

What lowers risk: bone drugs

Drug and trial	Women	Result
Alendronate, FIT 1¹⁸	Low BMD plus vertebral fracture	New vertebral fracture 8.0% vs 15.0%; hip RH 0.49
Alendronate, FIT 2¹⁹	Low BMD, no vertebral fracture	Clinical fractures cut 36% only if T-score -2.5 or lower (NNT 15); no benefit above it
Zoledronate, HORIZON⁴	Osteoporosis, mean age 73	Vertebral 3.3% vs 10.9%; hip 1.4% vs 2.5%
Zoledronate, 18-monthly²⁰	Osteopenia, 65 and over	Fragility fracture HR 0.63; NNT 15 over 6 years
Zoledronate, 2 doses²	Aged 50-60, T-score 0 to -2.5	New vertebral fracture RR 0.56 over 10 years
Denosumab, FREEDOM³	Osteoporosis, 60-90	Vertebral 2.3% vs 7.2%; hip 0.7% vs 1.2%

The 2025 zoledronate trial is the only fracture trial focused on women aged 50 to 60. Two infusions, five years apart, cut new vertebral fractures. It is one trial, its main outcome was X-ray vertebral fracture, and it has not yet shaped guidelines².

Stopping denosumab without a follow-on drug raises vertebral fractures to 7.1 per 100 patient-years²¹.

Evidence grade: High for women with osteoporosis; moderate for osteopenia and the 50-60 group.

Putting it together: a practical order

Everyone: food calcium, vitamin D repletion, resistance and balance training, no smoking, low alcohol⁵.
Symptoms and under 60 or within 10 years of menopause: MHT treats symptoms and protects bone²².
Fragility fracture, T-score -2.5 or high FRAX: start a bone drug, usually a bisphosphonate^{5, 8}.
Osteopenia only: decide on FRAX, not T-score alone^{5, 19}.
Denosumab: always plan the switch before stopping²¹.

Where the evidence is weak

No trial with fracture as the primary outcome in perimenopausal women except the single 2025 zoledronate trial².

No Indian fracture incidence data for this age group; FRAX India is uncalibrated⁵.

OUTSIDE INDIA FRAX was built from 9 population cohorts and checked in 11 more; clinical risk factors plus hip BMD gave a hip-fracture gradient of risk of 4.2 per SD at age 50²³. Not Indian data; use as a guide.

Exercise and calcium reduce bone loss more clearly than they reduce fractures^{11, 12}.

Questions

Common questions

How common are fractures in women aged 50 to 60?: In a New Zealand trial of women aged 50 to 60, 11.1% of the placebo group had a new vertebral fracture on X-ray over 10 years. In WHI, 11.1% of the placebo group aged 50 to 79 had any fracture over about 5.6 years.
Does a previous fracture raise the risk of another?: Yes. A vertebral fracture raises the risk of another vertebral fracture about 5-fold and of other fractures 2- to 3-fold.
Should a woman with osteopenia alone take a bone drug?: Usually not on T-score alone. In FIT, alendronate cut clinical fractures only when the T-score was -2.5 or lower. FRAX should guide the decision in osteopenia.
Does exercise prevent fractures?: Exercise raises BMD a little. A Cochrane review of 43 trials found small BMD gains but could not show fewer fractures. It still helps muscle strength and falls.

For patients

Plain-language guides

References23 sources, linked to PubMed or DOI

Verified by PMID and DOI. Vancouver style.

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Bolland MJ, Nisa Z, Mellar A, et al. Fracture Prevention with Infrequent Zoledronate in Women 50 to 60 Years of Age. N Engl J Med. 2025. PubMed 39813642 · doi:10.1056/NEJMoa2407031
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This article is for healthcare professionals. It is not medical advice for individual patients and doesn’t replace clinical judgement or a consultation.