A person who breaks a hip faces a one-in-five chance of dying
Across Africa, a silent epidemic of broken bones is quietly claiming lives at rates that would be considered alarming anywhere in the world — yet it remains absent from the policy conversations that could prevent it. The International Osteoporosis Foundation has published a strategic roadmap calling on governments, universities, and health systems to treat fragility fractures as the public health emergency the data demands. With hip fractures projected to double by 2050 and post-fracture mortality reaching 30 percent in some regions, the continent faces a preventable crisis whose window for intervention is narrowing. What is known about prevention is not in question; what remains unresolved is whether the institutions with the power to act will choose to do so.
- A person who breaks a hip in Africa faces up to a one-in-three chance of dying within months — not because the condition is untreatable, but because the systems to treat it largely do not exist.
- Bone health is invisible in most African national health strategies, medical school curricula, and hospital planning, leaving an entire continent's aging population exposed to a preventable and growing burden.
- The International Osteoporosis Foundation has issued a four-year strategic roadmap with five concrete priorities — from embedding bone health into NCD frameworks to establishing Fracture Liaison Services in hospitals across the region.
- Early pilots in Algeria, Egypt, South Africa, and Tunisia show that coordinated fracture care is achievable on the continent, proving the infrastructure can be built with the expertise already present.
- Without urgent action, demographic aging will drive a doubling of hip fractures by 2050 — a trajectory the roadmap argues is not inevitable, but only avoidable through deliberate political and institutional commitment.
Across Africa, a fragility fracture — the kind that comes from a simple fall in an aging body — carries a mortality risk of 20 to 30 percent. That figure reflects not just the severity of broken bones but the near-total absence of the coordinated care systems that catch people after they break. In wealthier countries, a fractured hip triggers surgery, rehabilitation, bone density screening, and preventive medication. In much of Africa, it more often leads to disability, lost independence, and premature death.
The International Osteoporosis Foundation has responded with a strategic editorial published in Osteoporosis International, authored by IOF board members from across the African region. Their roadmap identifies five priorities for the next four years: integrating bone health into national non-communicable disease strategies, establishing Fracture Liaison Services in hospitals, embedding bone health education in medical and nursing training, building fracture registries to generate local data, and forging partnerships with private and philanthropic funders to expand diagnostics and awareness.
The urgency is demographic as much as clinical. Africa's populations are aging, and hip fractures are projected to double by 2050 if current neglect continues. Yet the science of prevention is not new or uncertain — osteoporosis is well understood, and effective interventions exist. What has been missing is the translation of that knowledge into African health systems.
Some foundations are already in place. Fracture Liaison Services have been piloted in Algeria, Egypt, South Africa, and Tunisia. Bone density scanners are becoming more available in several countries. Lead author Professor Leith Zakraoui frames the challenge as one of adaptation — applying global knowledge to local realities — while IOF president Nicholas Harvey has called on governments, universities, and the private sector to treat bone health as a priority worthy of real investment. The roadmap exists. The question is whether the political will to follow it will arrive before the fracture burden becomes catastrophic.
Across Africa, a person who breaks a hip faces a one-in-five chance of dying within months. For some, the odds are worse—mortality after a fragility fracture reaches as high as 30 percent in parts of the continent. Yet bone health barely registers in the national health strategies of most African countries, absent from medical school curricula, invisible in hospital planning, and largely ignored by policymakers who face competing crises.
This gap between the scale of the problem and the absence of coordinated response prompted the International Osteoporosis Foundation to publish a strategic roadmap in the journal Osteoporosis International. The editorial, authored by IOF board members from across the African region, lays out what needs to happen over the next four years if the continent is to prevent what the data suggests is coming: a doubling of hip fractures by 2050, driven by aging populations and the persistent neglect of prevention and early care.
The numbers alone justify alarm. Post-fracture mortality across Africa sits at 20 to 30 percent—a figure that reflects not just the severity of the fractures themselves but the absence of the systems that catch people after they break. In wealthier countries, a broken hip triggers a cascade of coordinated care: orthopedic surgery, rehabilitation, screening for underlying bone disease, medication to prevent future fractures. In much of Africa, a fracture often means disability, loss of independence, and early death. The burden falls heaviest on aging populations with limited access to diagnostics, treatment, or follow-up.
The IOF's response centers on five concrete priorities. First, bone health must be woven into national strategies for non-communicable diseases and universal health coverage—not as a separate initiative but as part of the existing architecture of health systems. Second, hospitals need Fracture Liaison Services, dedicated teams that identify patients after a fracture and ensure they receive screening and preventive treatment. Third, medical schools and nursing programs must teach bone health as a core competency, so the next generation of doctors and nurses can recognize and manage fragility fractures. Fourth, countries need registries and observatories to track fractures and outcomes, generating the local data that guides clinical decisions and policy. Fifth, the foundation calls for partnerships with private companies and philanthropic organizations to fund diagnostics, training, and public awareness.
Some momentum already exists. Fracture Liaison Services have been piloted in Algeria, Egypt, South Africa, and Tunisia. DXA scanners—the machines that measure bone density and identify people at risk—are becoming more available in several countries. These examples prove that change is possible, that the infrastructure can be built, that the expertise exists within Africa itself.
Professor Leith Zakraoui, the lead author and an IOF board member based at the University of Tunis El Manar, frames the challenge as one of translation: taking what is known about preventing fractures and making it real in African contexts, respecting local realities while meeting international standards. The IOF president, Nicholas Harvey, issued a broader call to governments, universities, health agencies, and private sector leaders to treat bone health as a public health priority worthy of investment and coordination.
What makes this moment significant is not the novelty of the science—osteoporosis and fragility fractures are well understood globally—but the recognition that Africa has been left behind in the systems and resources needed to prevent them. An aging continent faces a preventable crisis. The roadmap exists. The question now is whether the institutions with the power to act will treat bone health as urgent enough to demand the coordination, funding, and political will required to build it into the fabric of African health systems before the fracture burden becomes catastrophic.
Notable Quotes
We envisage a targeted, Africa-driven strategy that is informed by local realities and harmonized with international standards. By transforming evidence into action, we can build bone health into the fabric of health systems, education, and policy.— Professor Leith Zakraoui, IOF Board member and Lead Author, University of Tunis El Manar
We should not stand by as disability and premature death increase due to preventable fractures. Together, we have both the opportunity and the responsibility to reshape the future of bone health across Africa.— Professor Nicholas Harvey, IOF President, University of Southampton
The Hearth Conversation Another angle on the story
Why does bone health matter so much in Africa right now, specifically?
Because the continent is aging, and it hasn't built the systems to catch people when they break. A hip fracture in Africa often means death or permanent disability. In wealthy countries, it's a managed event. There, it's a crisis.
The 20 to 30 percent post-fracture mortality—is that because of the fracture itself, or what happens after?
It's what happens after. Or doesn't happen. No surgery, no rehabilitation, no screening for bone disease, no medication to prevent the next break. People lie in bed and develop infections, blood clots, pneumonia. The fracture is the trigger, but the system failure is the killer.
So this editorial is saying the solution isn't new drugs or new technology?
Not primarily. It's saying: teach doctors about bone health, set up teams in hospitals to follow fracture patients, collect data so you know what's actually happening, get the machines that measure bone density into the hospitals that need them. The knowledge exists. The tools exist. What's missing is the coordination.
Why has bone health been invisible for so long?
Because it competes with everything else—malaria, HIV, maternal mortality, tuberculosis. Bone health feels like a rich-country problem. But Africa's population is aging, and fragility fractures are becoming a mass event. The IOF is saying: this is not a luxury. This is urgent.
What does success look like in four years?
Fracture Liaison Services in major hospitals across the continent. Medical schools teaching bone health. Countries collecting data on fractures so they can see the real burden. Private companies and foundations funding the diagnostics and training. It's not revolutionary. It's just making bone health visible and systematic.
And if nothing changes?
Hip fractures double by 2050. Millions of people lose independence or die from something preventable. A health crisis that was entirely avoidable becomes a catastrophe.