“I have no idea who does the bone thing” A qualitative exploration of older women and healthcare professionals’ experiences to guide improvements in osteoporosis care.

Background The Older Women's Health Strategy for England highlighted the systemic under-representation of older women in healthcare. Over half of women over 80 are estimated to have osteoporosis, contributing to 180,000 fractures annually in the UK, with substantial personal and economic costs, despite clinically effective treatments and national guidelines being available. Aim To use insights from the experiences of older women and primary healthcare professionals to develop strategies to improve osteoporosis care. Design/Setting A community-based study in England, UK. Method Interviews with 30 community-dwelling older women (aged 70+) diagnosed with osteoporosis, and 31 healthcare professionals including GPs, physiotherapists, pharmacists, practice nurses, a healthcare assistant, and a community matron. We reviewed findings iteratively with our co-production group using a Constructivist Grounded Theory approach. Results Healthcare professionals acknowledged osteoporosis as clinically important but described limited knowledge and understanding. However, older women assumed expertise and proactive engagement from clinicians. Older women normalised symptoms as part of ageing frequently prioritising other co-morbidities. Most were unclear about their diagnosis, prognosis, or treatment plans. Self-management was expected but inadequately supported. There was little routine engagement with the wider primary care team. Digital communication further limited older women's engagement/re-engagement. Conclusion Osteoporosis remains poorly understood and inadequately managed in older women who face barriers, including multimorbidity, digital exclusion, and low self-efficacy. Many older women accept care gaps due to limited awareness and lack of meaningful interaction with healthcare professionals. Improved care navigation and greater involvement of the wider primary care team could enhance engagement and support better self-management.