NICE updates osteoporosis guidelines: what you need to know

Most people do not know they have osteoporosis until they break a bone. New guidance from NICE aims to help identify people at risk earlier, so they can get the right assessment, treatment and support to help prevent future broken bones.

On 29 July 2026, the National Institute for Health and Care Excellence (NICE) published an updated guideline on assessing the risk of osteoporosis and broken bones caused by osteoporosis.

The guideline explains who should have a fracture risk assessment, and who may need one based on their individual risk factors. It also explains when bone density (DEXA) scans should be used, how hidden spinal fractures can be found, when treatment should be considered, and what support people should receive if they are not having treatment.

The overall approach to assessing the risk of osteoporosis has not changed significantly. Healthcare professionals will still use a combination of medical history, risk factors, fracture risk tools, and bone density (DEXA) scans to understand someone’s bone health.

However, there are some important updates that aim to help more people at risk of osteoporosis be identified earlier, find hidden spinal fractures, and make sure people receive the right support at the right time.

What’s changing?

1. Clearer guidance on who should have a fracture risk assessment.

The updated guideline gives healthcare professionals clearer advice about who should be offered a fracture risk assessment, who may benefit from one based on their individual risk factors, and who may need specialist advice.

People who should be offered an assessment include those at higher risk, such as adults over 50 who have already broken a bone easily or those who take steroids (glucocorticoids) regularly.

People who may benefit from an assessment include those who may have an increased risk of osteoporosis, such as older adults or people with other risk factors, including a family history of hip fracture, low body weight or certain medical conditions.

Some people may need specialist advice, including people under 30, people with rare forms of osteoporosis such as pregnancy-associated osteoporosis, or people with other rare bone diseases.

The aim is to help identify people at risk of osteoporosis earlier, before they experience a serious fracture, so they can receive the right support and treatment if needed.

2. Hidden spinal fractures could be found earlier

A key change in the guideline is the recommendation to consider doing a quick spine check, called a vertebral fracture assessment (VFA) at the same time as a bone density (DEXA) scan for more people.

A VFA is a quick, low-dose X-ray of the spine that takes just a few minutes. It can help find hidden spinal fractures, which are often missed because they do not always cause obvious symptoms.

The guideline recommends considering a VFA scan for women aged 60 and over, men aged 70 and over, and some younger people with additional risk factors.

Finding spinal fractures earlier means people can get the right support and treatment sooner. This can help reduce the risk of further broken bones and help people maintain their mobility, independence and quality of life.

3. A new approach to DEXA scans

A DEXA scan measures bone density and helps healthcare professionals decide whether someone has osteoporosis and whether treatment is likely to help.

A key change is that some people can now go straight to a DEXA scan without first having a fracture risk assessment using FRAX or QFracture. This includes people aged 30 and over who have had:

• a hip fracture

• a spinal fracture or

• two or more broken bones caused by osteoporosis.

For these people, this could mean a quicker diagnosis and earlier treatment if needed.

For other people, NICE has introduced a new threshold for when a DEXA scan should be considered. This new threshold is simpler, more consistent and replaces the previous age-based approach.

In practice, this means some people may be referred for a DEXA scan sooner, while others may not need one if it is unlikely to change their care. The aim is to make sure DEXA scans are used for the people who are most likely to benefit.

The guideline also clarifies that most people do not need another DEXA scan within two years. This is because changes in bone density are often too small to measure reliably over a short period. Instead, repeat scans should be based on a person's individual circumstances, such as changes in their health, risk factors or treatment plan.

4. More support and follow up for people not having treatment

The updated guideline recognises that not everyone assessed for osteoporosis will need treatment straight away. It recommends that people who are not having treatment should still receive advice and follow-up support. This includes:

• being told how they can access support again if their circumstances change

• being advised to contact their healthcare professional if they change their mind about treatment or their health changes

• having their fracture risk reviewed over time where appropriate.

This means people who are not starting treatment can continue to be monitored, so changes in their risk of osteoporosis can be identified and acted on.

What could this mean for me?

Most people will not notice an immediate change. NHS organisations will need time to review the updated guidance and put it into practice locally.

But over time, the changes could mean:

• More people are assessed before they break a bone. Clearer guidance will help healthcare professionals identify people at higher risk of osteoporosis, including people who have not yet broken a bone.

• More hidden spinal fractures are found. Adding a quick spine check alongside some DEXA scans could identify spinal fractures that might otherwise go undetected, helping people get the right care sooner.

• Some people may get a DEXA scan sooner. People who have had a broken hip, spinal fracture or two or more broken bones can now be referred directly for a DEXA scan, helping to speed up diagnosis and treatment.

• DEXA scans will be used where they can make the biggest difference. The new threshold provides a simpler and more consistent approach for deciding when a DEXA scan should be considered. It aims to make sure people most likely to benefit are prioritised.

• Fewer unnecessary repeat scans. Most people will not need another DEXA scan within two years unless their circumstances have changed.

• Better support for people not having treatment. People who do not start treatment will have clearer advice about follow-up support.

Overall, the updated guideline aims to make osteoporosis risk assessment more consistent and help people at highest risk to be identified earlier and receive the right care sooner.

What should you do if you're concerned about osteoporosis?

If you are worried about your bone health, think you may be at risk of osteoporosis, or have had a broken bone after a minor bump or fall, visit our Information and Support pages. We have trusted information about osteoporosis, risk factors, diagnosis, treatment and living well with the condition.

You can also speak to your GP. They can assess your fracture risk and decide whether you need further assessment, including a DEXA scan or, where appropriate, a spine check (vertebral fracture assessment).

If you have already been diagnosed with osteoporosis or are receiving treatment, the guideline changes are unlikely to affect your current care straight away.

We will continue to review the updated guidance and update our information so you can understand what the changes mean for you.