I was kneeling on my mat in a Pilates class. ‘Now let’s move into a bird-dog rotation,’ said the teacher. I beg your pardon? I dutifully copied her, bringing one knee to the opposite elbow and out again, until...
Ouch. The strangest sensation shuddered in my lower back.
What had I done? Something definitely wasn’t right. I sat out the rest of the class and assumed I’d pulled a muscle.
Little did I know this was the point at which I fractured my spine.
I was 62 at the time, and it was the start of years of agony before finally an investigation concluded I had poor bone density or, to give it its medical name, osteopenia. It is very far from usual to sustain a fracture doing Pilates, of course. But when your bones are losing density, almost anything can trigger a stress fracture. A simple twist, even a sneeze.
The fact is, I should have known that my bone health was poor, but I didn’t. In 2019 – three years before that Pilates class – I’d tripped over my trousers and face-planted into a kerb. It was a small fall, yet I fractured both arms and had to undergo extensive surgery on my right wrist. I now know these are called ‘fragility fractures’– the type that come from minor falls that shouldn’t break bones, and they’re a strong sign that bone density is compromised.
Indeed, according to NHS guidelines, if you’ve broken a bone from a minor fall and are aged 50 or over, you should be referred to the local fracture liaison service for further tests. If osteopenia is found, treatment can be started to stop it turning into the more serious osteoporosis, where bone loss is advanced and breakages can be catastrophic.
But that didn’t happen to me in 2019.
Jane Alexander fractured her spine during a Pilates class and later discovered she has osteopenia, or poor bone density
In fact, it transpires that my hospital in Devon doesn’t have a fracture liaison service. According to the Royal Osteoporosis Society, only half of NHS trusts do, making diagnosis and treatment of poor bone density the subject of a horribly unfair postcode lottery.
The Royal College of Physicians estimates that 90,000 people are in the same boat –unaware that they have osteopenia and are therefore at very high risk of osteoporosis with all its nasty implications for future quality of life. The weeks that followed that Pilates class in 2022 were agony. My back kept going into spasm and I was living on painkillers.
With the benefit of hindsight, I should have sought medical help. However, I didn’t go to my GP at the time because I thought my problem was purely muscular, and eventually, after several months, the pain eased off and I got back to normal life, albeit cautiously.
Of course, the serious, yet hidden, weakness of bone loss remained. A year later, in 2023, I picked up a skipping rope at a circuits class, took one skip and felt that telltale ‘wrongness’ in my back again. The spasms returned. I confess I didn’t go to my GP that time either.
I didn’t think they could do much and, like many people, I didn’t want to ‘overburden’ the NHS.
The following year, in April 2024, I was helping a friend move and, you’ve guessed it, my back went into spasm again. This time was the worst of all. I couldn’t walk or even stand for very long and the pain was terrifying. So, this time I made an appointment with my GP the following month hoping I could get some stronger pain relief and was referred to the practice physio who got me on codeine, and booked me in for an X-ray.
That’s when I found out I had several fractures of the thoracic spine – the middle section. ‘No wonder you were in such pain,’ my GP said. ‘You’ve been walking round with a broken back!’ And then, finally, the magic words: ‘We need to talk about bone density scans and treatment.’
My DEXA scan (a low-dose X-ray scan that measures bone strength and mineral density) showed I was only a hair’s breadth away from full-blown osteoporosis. I was prescribed a calcium and vitamin D3 supplement and told the scan would be repeated in a few years.
Two years after the Pilates class, Jane visited the GP and was told she had been walking around with a broken back
It really shook me. If you can’t rely on your bones, your very foundation, the world feels precarious. I was terrified of falling again, petrified of my back going into spasm. My faith in the NHS also faltered. Was a vitamin and mineral supplement really enough?
I decided to get a second, more detailed and comprehensive investigation, and booked an evaluation at private London health clinic Reborne Longevity. They ran blood and urine tests and gave me a DEXA scan that offers full body scanning (not just looking at bone density but also at the breakdown of fat, muscle, and bone in arms, legs and trunk).
And here the diagnosis was again terrifying. ‘You’re one-tenth of a point away from osteoporosis and have a high risk of future fracture,’ said Dr Hind Abdulkader, one of the clinic’s GPs. ‘You clearly had significant bone fragility that existed before your formal diagnosis. In fact, even without the scan, your fractures are diagnostic of skeletal vulnerability.
‘Your situation is not unusual. It is, unfortunately, entirely typical.’
The Royal Osteoporosis Society has established that there are as many deaths from fracture-related causes as there are from lung cancer. Broken hips are the main danger (up to 30 per cent of adults over 50 die within 12 months of fracturing a hip and the increased risk of death remains for almost ten years – key causes include pneumonia, blood clots and stroke, all of which can come from a sudden loss of mobility).
Yet the condition receives a fraction of NHS investment. ‘Up to 80 per cent of people who have already had at least one osteoporotic fracture are neither identified nor treated,’ said Dr Abdulkader. ‘Jane, you fell into this group for at least five years.’
She explained that between 2019 (when I fell and broke bones) and 2024 (when I received my osteopenia diagnosis) I had a years-long window ‘during which bone loss was continuing, vertebral fractures were forming and no protective treatment was in place’. What she said next was chilling: ‘Early intervention in 2019 could have meaningfully changed the trajectory of your bone health.’
To make things worse, I had been taken off HRT (which has bone-protective properties) by my GP when I moved to the practice in 2016. My doctor said the risks of breast cancer were too high, although I do not have a personal or family history of the disease.
Three years before the Pilates class, Jane had a small fall but had to undergo extensive surgery on her wrist
‘Bone loss accelerates sharply in the first five to ten years after your last period, when oestrogen levels fall rapidly,’ says Dr Abdulkader. ‘So your skeleton was losing bone at an accelerated rate without hormonal protection. It will have left its mark.’ But lots of women don’t take HRT and don’t develop bone loss. Why me?
It’s partly genetic, said Dr Abdulkader (my mother had osteoporosis) but she also came up with some further surprising risk factors. Taking lots of antibiotics as a child, which was a box I ticked as a girl who had frequent chest infections.
‘Heavy antibiotic use, particularly in early life, disrupts the gut microbiome,’ said Dr Abdulkader, ‘which can reduce lifelong absorption efficiency of calcium, magnesium and vitamin D from food, even when your diet seems good. You’re eating well but not absorbing the micronutrients.’
I also have palindromic rheumatism, a rare auto-immune condition that causes periodic inflammation of the joints. ‘Chronic systemic inflammation, even at low levels, suppresses the cells responsible for building new bone and activates the cells that break bone down,’ she said.
My history of gallstones could also play a role. ‘Gallstone disease impairs the absorption of fat-soluble vitamins. Vitamin K2, essential for directing calcium into bone, is frequently deficient in people with gallbladder conditions.’ To cap it all my tests showed that my testosterone and DHEA (both bone-protective hormones – the latter helps produce the former) levels are non-existent or perilously low.
‘It’s complex,’ says Dr Abdulkader. ‘Each factor compounds the others. The encouraging news is that most of these are addressable.’ She strongly recommended I go on anti-fracture medication (the most common are bisphosphonates that help build new bone). She was pleased I had demanded to go back on HRT a couple of years ago at the age of 63 (‘you’ve missed many years of protection but at least it’s happening now’) and suggested it would be worth supplementing testosterone and DHEA. Further tests to ascertain my levels of vitamin K2 and the omega-3 fatty acids (EPA/DHA) would be wise. I should continue to exercise carefully, ideally under the guidance of an osteoporosis-aware PT.
I’m now armed with the information I need to go back to my GP and form a clear plan. Why was I not put on bone strengthening medication after that first DEXA scan, especially combined with my history of fragility fractures?
‘A busy GP with a ten-minute appointment, a patient presenting with a fracture requiring orthopaedic management, and no automated system prompting a bone health referral – this is the gap you fell through,’ said Dr Abdulkader. ‘It’s not uncommon.’
Very few of us can afford the luxury of private clinics – we rely on our GPs and hospitals to look after our bones. And in all too many cases it looks like there is much room for improvement.
Early diagnosis would actually save the NHS millions. The Royal Osteoporosis Society says that if everyone in England alone had access to a fracture liaison service it could prevent 74,000 fractures over five years and save the NHS £665 million while releasing 750,000 bed days (even when factoring in the cost of the FLS).
Meanwhile, I’m in limbo, waiting for an appointment with my GP in the hope that I can persuade her to put me on medication (it’s not a given as I technically don’t have full-blown osteoporosis, even though I’m a fraction away from it).
It’s also highly unlikely I will be able to get testosterone as the NHS only prescribes it for low libido (so I may need to get a private prescription for that). It’s left me feeling uncertain and, to be truthful, scared.
I’m terrified of breaking more bones. So many decisions feel perilous: should I do this exercise class? Could I risk going horse-riding (what if I fell)? Dare I chance a walk that involves steep declines?
I’m on high alert to any twinges, petrified they’ll turn into spasms. And, needless to say, I’m steering clear of bird-dog twists.