Conditions & Rehab

The Cost of Not Treating Osteoporosis: Economic & Clinical Case | Physio to Home

Michael Ghattas, Physiotherapist6 March 2026

Osteoporosis-related fractures cost Australia over $3.8 billion annually — yet prevention remains dramatically underinvested. A North Tasmania physiotherapist examines the economic and clinical case for proactive management.

Micheal Ghattas

3/6/2026 · 9 min read

The Economic and Clinical Cost of Undertreated Osteoporosis in Australia: A Case for Proactive Physiotherapy

By Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience

Physio to Home, North Tasmania | Last reviewed: March 2026

*This article is written for people with osteoporosis, their families, GPs, aged care planners, and health policymakers. It draws on published health economic data, clinical guidelines, and the physiotherapy evidence base to make the case for proactive osteoporosis management — and examines what happens when that management does not occur.*

The Scale of the Problem

Osteoporosis affects approximately 924,000 Australians — around 3.5% of the total population — according to the Australian Institute of Health and Welfare. In people over 50, the prevalence rises sharply: osteoporosis affects approximately 1 in 3 women and 1 in 5 men in this age group. In people over 70, it is close to universal in women.

Despite its prevalence, osteoporosis is dramatically undertreated. A 2021 report by Osteoporosis Australia estimated that only approximately 20% of people with osteoporosis in Australia were receiving appropriate pharmacological treatment — a treatment gap of approximately 80%. The physiotherapy and exercise dimension of management fares no better. The majority of people with a confirmed osteoporosis diagnosis have never been referred to a physiotherapist for a bone-appropriate exercise programme.

This treatment gap has consequences that can be counted in dollars, in hospital beds, and in lives.

The Economic Cost of Osteoporosis-Related Fractures

The direct and indirect costs of osteoporosis-related fractures in Australia are substantial and growing as the population ages.

According to the *Burden of Disease Study* published by the Australian Government and analyses by Osteoporosis Australia:

Direct healthcare costs of osteoporosis-related fractures — including hospitalisation, surgery, rehabilitation, residential aged care transitions, and community care — total approximately $3.84 billion annually in Australia. This figure includes hospital admission costs, which represent the largest single component, and post-acute care costs in the community and residential settings.

Hip fracture alone accounts for a disproportionate share of this burden. The average cost of a single hip fracture — from emergency admission through surgical repair, inpatient rehabilitation, and the first year of post-discharge care — is estimated at between $27,000 and $60,000 per patient, depending on the level of post-fracture disability and ongoing care requirements. With approximately 23,000 hip fractures occurring in Australia each year, the annual direct cost of hip fracture alone exceeds $600 million.

Vertebral compression fractures are the most common osteoporotic fractures — affecting an estimated 50,000 Australians annually, many of whom do not seek medical care. When they do present, the costs include diagnostic imaging, specialist review, pain management, and — in a significant proportion of cases — the cascade of functional decline, residential aged care transition, and the loss of the community-dwelling status that represents independence.

Indirect costs — including productivity losses (affecting carers and the working-age people who support affected family members), the value of unpaid care, and the quality-adjusted life years (QALYs) lost to fracture-related disability — add further to the economic burden. The Productivity Commission estimates that musculoskeletal conditions including osteoporosis account for approximately $24 billion in total economic cost annually in Australia when indirect costs are included.

The Human Cost: What Fractures Actually Do to Lives

Behind the economic figures are clinical realities that numbers inadequately convey.

Hip fracture and one-year mortality. The one-year mortality rate following hip fracture in older adults is approximately 20–30% in Australian cohort studies. This means that for every 100 older Australians who sustain a hip fracture, 20–30 will be dead within twelve months. The excess mortality is driven by complications of immobility (pneumonia, pulmonary embolism, deconditioning), the physiological stress of surgery in a frail patient, and the downstream consequences of acute hospitalisation in older adults.

Permanent institutionalisation. Among hip fracture survivors, approximately 25–30% who were living in the community before their fracture will not return to the community — transitioning instead to permanent residential aged care. For many individuals, a hip fracture is the event that ends independent living.

Functional decline and loss of independence in survivors. Of those who do return to community living after hip fracture, most do not fully recover their pre-fracture function. A systematic review by Auais and colleagues (2012) found that only approximately 40–60% of community-dwelling hip fracture patients achieve their pre-fracture level of mobility within one year, and a substantial proportion experience permanent reductions in walking speed, balance confidence, and daily activity capacity.

The cascade of vertebral fractures. Each vertebral compression fracture significantly increases the risk of subsequent vertebral fractures — a phenomenon sometimes called the vertebral fracture cascade. A person who has had one vertebral fracture has approximately five times the risk of a subsequent vertebral fracture compared to the general population. Successive fractures produce progressive kyphosis, height loss, chronic pain, and — through the effects of thoracic kyphosis on lung mechanics — increasing respiratory compromise.

What Proactive Management Prevents: The Evidence

The evidence for the effectiveness of osteoporosis management — pharmacological and non-pharmacological — in reducing fracture risk is strong and well-established.

Pharmacological treatment

First-line pharmacological treatment for osteoporosis — primarily bisphosphonates, which reduce osteoclast activity and slow bone resorption — reduces the risk of vertebral fracture by approximately 40–70% and hip fracture by approximately 40–50%, according to meta-analyses published in the *BMJ* and the *New England Journal of Medicine*. Given the cost of a single hip fracture, the pharmacoeconomics of bisphosphonate treatment are strongly favourable — with cost-per-QALY estimates well within standard Australian willingness-to-pay thresholds.

The treatment gap — 80% of osteoporosis patients not on appropriate pharmacological treatment — represents a massive unrealised prevention dividend.

Exercise and physiotherapy

The evidence for exercise-based intervention in osteoporosis management operates through two distinct mechanisms: direct effects on bone mineral density, and indirect effects through falls prevention and strength improvement.

Direct bone effects. Progressive resistance training and impact exercise stimulate osteoblast activity and bone formation at loaded sites. The LIFTMOR trial (Watson et al., *Journal of Bone and Mineral Research*, 2018) — conducted at Griffith University — demonstrated that a twice-weekly, high-intensity progressive resistance and impact training programme produced significant increases in femoral neck bone mineral density, lumbar spine bone mineral density, and functional strength in postmenopausal women with osteoporosis or osteopenia. Crucially, this was a high-intensity programme, not gentle exercise — with loads at 85% of 1-repetition maximum. The programme was supervised and specifically designed for safety in osteoporotic participants.

Falls prevention effects. The Cochrane systematic review on falls prevention (Sherrington et al., 2019) — covering 108 trials — found that exercise programmes specifically incorporating balance training reduced falls rates by 23% in community-dwelling older adults. For people with osteoporosis, where a fall is the mechanism of most fractures, a 23% reduction in falls rate translates directly to a meaningful reduction in fracture incidence.

Combined programmes. The combination of pharmacological treatment and structured physiotherapy produces outcomes superior to either alone. A 2020 analysis published in *Osteoporosis International* found that patients receiving both pharmacological treatment and supervised exercise had significantly lower fracture rates at 3-year follow-up than patients on medication alone.

The Cost-Effectiveness of Prevention: A Health Economic Argument

The health economic case for proactive osteoporosis management — including physiotherapy — is compelling at the system level.

A structured physiotherapy programme for osteoporosis — involving an initial assessment and exercise prescription visit, monthly review visits, and a daily home exercise programme — costs approximately $600–1,200 per year in direct physiotherapy costs, depending on frequency and funding pathway. For patients receiving My Aged Care funding or Medicare GP Management Plan subsidies, the out-of-pocket cost to the individual is considerably lower.

Compare this to the cost of the fracture that proactive management is designed to prevent: $27,000–$60,000 per hip fracture, in a patient population where the annual fracture risk without intervention is approximately 3–5% in people with established osteoporosis and prior fracture.

The expected value calculation is straightforward. In a cohort of 100 people with high-risk osteoporosis, an annual fracture rate of 4% means approximately 4 fractures per year, at an average cost of $40,000 each — a system cost of $160,000 per year, excluding the human cost. A physiotherapy programme that reduces falls and fractures by 23% prevents approximately one fracture per year in that cohort — saving approximately $40,000 in acute care costs for a physiotherapy investment of approximately $60,000–$120,000 (100 patients at $600–$1,200 per year).

In populations with higher fracture risk — those with prior fractures, severe osteoporosis, or significant falls history — the cost-effectiveness improves further.

This analysis does not include the downstream costs of residential aged care transition, permanent disability, or carer burden, all of which are reduced by fracture prevention. A full health economic model including these costs would show even stronger cost-effectiveness for the physiotherapy intervention.

Why the Treatment Gap Persists: Structural Barriers

Despite the compelling evidence and economics, the osteoporosis treatment gap — both pharmacological and physiotherapy — persists. Several structural factors maintain it:

The asymptomatic nature of osteoporosis before fracture. Osteoporosis produces no pain and no visible signs until a fracture occurs. The motivation to treat a condition that causes no current symptoms is structurally different from the motivation to treat a condition that is actively causing suffering.

The post-fracture care gap. A fracture is a teachable moment — the ideal opportunity to initiate comprehensive osteoporosis management. But the evidence consistently shows that secondary fracture prevention (initiating appropriate management after a first fracture) is poorly executed in Australia. Studies from the Osteoporosis Australia Fracture Liaison Service programme show that fewer than 30% of hip fracture patients leave hospital on appropriate anti-osteoporosis medication. The physiotherapy component of secondary prevention is even more poorly implemented.

Insufficient integration of exercise into osteoporosis guidelines communication. Australian and international osteoporosis guidelines explicitly recommend exercise — including progressive resistance training and balance work — as a core component of management. But the communication of this recommendation to patients and to referring clinicians is inconsistent. Many patients with a confirmed osteoporosis diagnosis have been told "be careful" and given calcium and vitamin D, without any discussion of exercise or referral to physiotherapy.

Rural access barriers. In communities like those in rural North Tasmania, where physiotherapy services are geographically concentrated and home-visiting options are limited, the exercise component of osteoporosis management is least accessible for the patients who most need it — older, rural women with established osteoporosis and high falls risk.

What Proactive Management Looks Like in Practice

For GPs, aged care coordinators, and patients in North Tasmania, proactive osteoporosis management through physiotherapy involves:

A home physiotherapy assessment that includes a review of the DEXA scan results and fracture history, a falls risk assessment, a postural screen, lower limb strength and balance testing, and a home hazard assessment.

A tailored exercise programme including progressive resistance exercises targeting hip and spinal bone density, balance training targeting falls prevention, and postural exercises addressing the kyphotic posture associated with vertebral fracture risk.

Education about which exercises are safe and which carry fracture risk, and clear guidance on physical activity levels appropriate to the individual's bone density and fracture history.

Coordination with the GP regarding pharmacological management, DEXA surveillance, and vitamin D and calcium supplementation.

Ongoing review at appropriate intervals — typically monthly or bi-monthly for active rehabilitation, with a maintenance programme thereafter.

Key Statistics Summary

924,000 Australians have osteoporosis — AIHW
Only ~20% of people with osteoporosis receive appropriate treatment — Osteoporosis Australia, 2021
Osteoporosis-related fractures cost Australia ~$3.84 billion annually — Osteoporosis Australia
One-year mortality after hip fracture: approximately 20–30% — Australian cohort data
~25–30% of hip fracture survivors do not return to community living — systematic review evidence
High-intensity resistance and impact training increases femoral neck BMD significantly — LIFTMOR trial, Watson et al., 2018
Exercise programmes with balance training reduce community falls rates by 23% — Cochrane Review, Sherrington et al., 2019
Bisphosphonates reduce hip fracture risk by ~40–50% — BMJ meta-analyses

About the Author

Michael Ghattas, DPT

AHPRA Registered Physiotherapist | Doctor of Physical Therapy | 18 Years Clinical Experience

Michael is the founder of Physio to Home, a mobile physiotherapy practice serving older adults and rural residents across North Tasmania. He specialises in osteoporosis management, falls prevention, and home-based rehabilitation for complex presentations.

Correspondence and GP referrals: physiotohome.com

References

Osteoporosis Australia. The burden of osteoporosis in Australia. www.osteoporosis.org.au, 2021.

Australian Institute of Health and Welfare (AIHW). Osteoporosis. Cat. no. PHE 232. Canberra: AIHW, 2020.

Watson SL, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteoporosis and osteopenia. *Journal of Bone and Mineral Research*, 2018.

Sherrington C, et al. Exercise for preventing falls in older people living in the community. *Cochrane Database of Systematic Reviews*, 2019.

Kanis JA, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. *Osteoporosis International*, 2019.

Auais MA, et al. Extended exercise rehabilitation after hip fracture improves patients' physical function. *Physical Therapy*, 2012.

Giangregorio LM, et al. Too fit to fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. *Osteoporosis International*, 2014.

Productivity Commission. Report on Government Services 2024: Primary and Community Health. Commonwealth of Australia, 2024.

Conditions & Rehab

Back to Blog