A Scoping Review of Barriers to Osteoporosis Treatment and Fragility Fracture Prevention in Adults Aged 50 and Above in the United Kingdom

Osteoporosis is a major public health condition characterised by reduced bone mass and impaired bone microarchitecture, resulting in an increased risk of fragility fractures. In the United Kingdom (UK), osteoporotic fractures-particularly of the hip, spine, and wrist-are associated with significant morbidity, mortality, and escalating healthcare costs. Despite the availability of effective pharmacological therapies and national clinical guidelines, a substantial treatment and prevention gap persists among adults aged 50 years and older. The primary aim of this scoping review was to identify and synthesise the key barriers to optimal osteoporosis treatment and fragility fracture prevention in the UK. A secondary aim was to examine how individual, socioeconomic, and health system factors contribute to underdiagnosis, undertreatment, and poor adherence to osteoporosis care. A systematic search of major electronic databases, including PubMed, SCOPUS, Embase, and CINAHL, was conducted to identify UK-based studies published within the last ten years that addressed osteoporosis management, fracture prevention, service delivery, or patient engagement. Data were analysed using thematic synthesis. The review identified multiple interacting barriers across the care pathway. Individual-level barriers included poor medication adherence, low risk perception, missed diagnostic appointments, and socioeconomic disadvantage. At the organisational level, challenges included delayed diagnosis, inconsistent initiation of therapy following fragility fractures, limited access to bone density assessment, fragmented care pathways, and suboptimal implementation of falls-prevention strategies. This review highlights the need for coordinated, system-wide interventions to improve osteoporosis outcomes in the UK. Strategies should focus on strengthening fracture liaison services, improving access to diagnostics, supporting long-term treatment adherence, and targeting high-risk and underserved populations to reduce preventable fragility fractures.