Bone Abstracts

Background: One in three women and one in five men over 50 experience osteoporotic fractures, which carry substantial morbidity, mortality, and healthcare costs. Despite this, only around 25% of at-risk individuals receive preventative treatment, highlighting a major care gap. As physiotherapy roles have expanded into enhanced, advanced, and consultant practice, there is potential for physiotherapists to contribute more to osteoporosis care. However, their capabilities in managing patients at increased fracture risk remain poorly defined. Clarifying these capabilities is essential to support evolving models of care. This scoping review aimed to map the extent and type of literature describing physiotherapy capabilities in the care of adults at increased risk of osteoporotic fractures and to identify gaps in the evidence base.

Methods: A scoping review was conducted following Joanna Briggs Institute (JBI) methodology. Eligible sources described the capabilities of qualified physiotherapists involved in the care of adults (≥18 years) at increased fracture risk in any setting. Eight electronic databases were searched (2003-2025), supplemented by a grey literature search. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. Data were extracted and synthesised using a descriptive analytical approach.

Results: Twenty-three reports from nine countries were included, comprising journal articles, conference abstracts, professional publications, and a professional magazine discussion piece. The literature represented physiotherapists across all practice levels and healthcare settings. Capabilities covered all domains of clinical practice: screening, referral and investigations, physiotherapy interventions (particularly exercise prescription and falls prevention), general condition management, and medication-related activities. Leadership, research, and education capabilities were also identified. Most capabilities focussed on knowledge and skills, with less emphasis on professional attributes. International variation reflected differences in scope of practice; for example, radiology requesting and non-medical prescribing were reported only in United Kingdom-based literature.

Conclusion: Physiotherapists contribute across all domains of osteoporosis care through a wide range of capabilities. However, their role remains variably defined and supported by limited, heterogeneous evidence. Strengthening the evidence base to clarify their role, scope of practice, and integration within multidisciplinary pathways across both primary and secondary care may help to optimise their impact in osteoporosis care.