Osteoporosis as a Silent Driver of Fragility Fractures: A Narrative Review of Risk Factors, Management, and Health System Gaps in Nigeria With Comparative Insights From the United Kingdom

Osteoporosis is a common yet underdiagnosed metabolic bone disease that silently reduces skeletal integrity until a fragility fracture occurs.This narrative review synthesizes evidence on risk factors, diagnostic practices, management, and health system gaps in Nigeria, with comparative insights from the United Kingdom (UK), drawing on targeted searches of PubMed, Google Scholar, and WHO IRIS (July 2026) and targeted checks during revision; cited publications span 1992 to 2026.Nigerian studies identify older age, female sex, and postmenopausal status as important factors, while evidence from the wider African and international literature suggests that vitamin D insufficiency, inadequate calcium intake, and diabetes may also contribute, although Nigeria-specific evidence is limited.Reported prevalence ranges from approximately 8.5% in a Lagos review of dual-energy X-ray absorptiometry (DXA) reports and 15% in a primary care DXA cohort to 57% in a hospital geriatric DXA cohort and 68% in a selected rural sample classified from self-reported indicators rather than densitometry.These estimates are not directly comparable, and the 68% figure is not DXA-confirmed prevalence.Community awareness appears low.DXA access is limited and unevenly distributed, and management appears largely reactive, with no documented coordinated fracture liaison services, whereas the UK has national frameworks for risk stratification, treatment, and postfracture follow-up, although implementation there is also uneven.Osteoporosis is likely to be a substantial, potentially preventable public health burden in Nigeria.Priority investments include public awareness, validated risk assessment tools, expanded diagnostic capacity, and structured postfracture care pathways, with contextually adapted elements of the UK model.