My neighbour, a woman in her 70s, once looked at a fracture risk estimate I gave her and shrugged.
"Fifteen percent?" she said. "That does not sound very high."
On paper, she was right. Fifteen percent over a five-year window looks small -- smaller than 50%, far from certainty, easy to dismiss as "probably not me."
But that small-looking number was trying to say something far more serious. Among 100 people like her, about 15 could break a bone within the next five years, a wrist, a vertebra, a hip. For some, that fracture would become the beginning of pain, surgery, loss of independence, admission to aged care, another fracture, or even premature death.
That moment captures the story behind my recent paper, "Beyond Fracture Probability: Communicating the Full Consequences of Fracture and Contextualization."
For many years, osteoporosis medicine has become very good at calculating risk. Tools such as FRAX and the Garvan Fracture Risk Calculator estimate a person's chance of having a fracture over the next five or ten years. These tools represent decades of research, and they help doctors identify people who may benefit from treatment.
But I began to worry that we were giving patients a number without giving them its meaning.
A percentage is precise, but it isn't always persuasive. It speaks the language of statistics, not the language of daily life. When we say, "Your fracture risk is 15%," we assume the patient understands the seriousness of that information. However, many people don't think in percentages; they think in stories, images, experience, family, mobility, and fear of becoming a burden.
Numbers are abstract. A person can hear "15%" and imagine low risk. Another can hear the same number and feel anxious. A third may not know what to do with it at all. Risk communication fails when a number is mathematically correct but emotionally and clinically incomplete.
There's a second reason behind the paper, and it may be even more important: many people don't realise that osteoporotic fracture is a serious health event.
In public thinking, osteoporosis is often seen as a disease of "thin bones," or as a natural consequence of old age. A fracture is imagined as an accident from a fall, a cast, some rest, then recovery. That may be true for some fractures, but not for many others, especially hip and vertebral fractures.
A hip fracture can change the course of a person's life. Before the fracture, someone may be living independently -- walking to the shops, cooking, gardening, caring for grandchildren. Afterward, that same person may need surgery, rehabilitation, walking aids, or permanent residential care. Some never regain their previous mobility. Others live with chronic pain, lose confidence, or suffer a second fracture soon after the first.
And some die earlier than they would have otherwise.
That's the part our current risk tools usually don't show. They tell a patient the probability of fracture, not its consequences. They answer "what is my chance of breaking a bone," but not the questions patients actually care about: What would that fracture mean for my life? Would I still be able to walk, still be independent? Could it shorten my life? And is there anything I can do about it?
This is why I argue that we need to move beyond fracture probability.
Risk shouldn't be communicated as a lonely number. It should be placed in context, shown visually, explained in terms of likely consequences, and paired with what treatment can actually change. People deserve to see not only the danger, but the possibility of prevention.
In my paper, I describe three gaps in current fracture risk communication.
The consequence gap: existing tools tell people their fracture risk, but rarely what a fracture might mean for survival, future fracture, pain, function, or independence.
The controllability gap: a person may be told they're at high risk without being shown how medication, fall prevention, exercise, calcium, or vitamin D could change that risk. Telling someone they're at risk without telling them what they can do about it tends to produce fear or resignation rather than motivation.
The format gap: many tools still present risk mainly as a percentage. But research in risk communication shows people often understand information better as natural frequencies -- "15 out of 100 people" -- or as images, such as icon arrays. A picture can make risk visible in a way a percentage can't.
The aim isn't to frighten patients; fear alone is rarely good medicine. The aim is to be honest, clear, and useful.
A fracture isn't just a bone event. It can affect health, mobility, independence, and in some cases, how long someone lives. At the same time, it isn't destiny. Osteoporosis can be diagnosed. Risk can be estimated. Falls can be reduced, bone strength improved, and effective treatments exist. The earlier we identify high risk, the better our chance of preventing the first fracture, or the next one.
That's the human story behind the paper. It began with a simple observation: we've become good at calculating fracture risk, but not good enough at explaining it.
A number like 15% may be statistically correct, but for the patient sitting in front of us, it's incomplete without a denominator, a picture, and a set of consequences attached to it. Above all, it needs to be connected to a decision, because what patients actually want to know isn't just their fracture risk. It's what that risk means for their life, and what they can do about it.
Note: The images were created with the assistance of ChatGPT.