Fractures and Losing Independence — What the Numbers Actually Say
Fractures and falls are now the second most common reason people come to need long-term care. How to read that statistic correctly — and why fractures are the cause with the clearest things you can do about them.
Ask someone with osteoporosis what worries them and the answer is rarely a bone density score. It is usually some version of the same thing: will I still be able to look after myself?
That worry deserves a straight answer. In July 2026, Japan published its latest national survey of long-term care, and one line in it moved. Fractures and falls are now the second most common reason people come to need long-term care, having overtaken stroke.
This article looks at what that finding means and what it does not mean. The picture is less bleak than the headline suggests. Of all the causes on that list, fractures are the one with the clearest steps you can take.
This video was created using AI voice and video technology. Content is supervised by a board-certified orthopedic surgeon.
1
Where fractures now rank
Japan's Comprehensive Survey of Living Conditions (国民生活基礎調査) is run every three years. The 2025 results were published in July 2026.
Main reason for needing long-term care (people certified at care levels 1–5)
Rank
Cause
2025
(2022)
1
Dementia
23.6%
23.6%
2
Fractures and falls
14.8%
(13.0%, 3rd)
3
Frailty of old age
14.5%
(10.9%, 4th)
4
Cerebrovascular disease (stroke)
14.4%
(19.0%, 2nd)
5
Joint disease
5.8%
(5.4%)
Stroke fell sharply, from 19.0% to 14.4%, a real public health success that reflects better prevention and treatment. Fractures and falls rose from 13.0% to 14.8%.
That said, second place (fractures and falls, 14.8%), third (frailty, 14.5%) and fourth (stroke, 14.4%) sit within 0.4 percentage points of each other. They are essentially level. The rank itself matters less than the direction: over three years stroke came down, and fractures and falls did not.
It is probably more accurate to say that fractures have not improved than that they have worsened. Other causes are falling; this one is not. We do not yet manage bone as routinely as blood pressure or cholesterol.
Note that these figures are for people certified at care levels 1–5. Including the lighter "support required" category shifts the ranking (dementia 16.7%, frailty 15.6%, fractures and falls 14.6%, stroke 12.5%, joint disease 9.1%). If you see different numbers elsewhere, this is usually why. Neither is wrong.
[!note] These figures are for people living at home
The survey is carried out by visiting households, so it covers people who live at home. People living in care facilities are not included.
One more thing in the same table
Care need in Japan is graded across seven levels. Most causes vary a great deal across them. Dementia accounts for 5.7% at the lighter "support" levels but 23.6% at care levels 1–5. Stroke moves from 9.4% to 14.4%.
Fractures and falls barely move at all: 14.7% at the lighter levels, 14.8% at the heavier ones.
So fractures are not concentrated among the most dependent. From support level 1 to care level 4 they sit between 13.8% and 16.1%. Only at care level 5, the most dependent, does the share drop to 10.1%, where stroke (27.6%) becomes the most common cause.
This is encouraging. People whose care need began with a fracture are not, as a rule, ending up at the severe end. Many of them stay where they started.
How to read the number correctly
This part is often misread, so here it is plainly.
14.8% means: of people who came to need long-term care, about 15 in 100 got there via a fracture or fall.
It does not mean that 15% of people who break a bone will need long-term care. Those are entirely different statements, and the survey measured only the first one.
In practice, many people break a hip, have surgery, do their rehabilitation, and go home to the life they had.
A Japanese study followed people for ten years after a hip fracture:
Before the fracture
One year later
Over the next ten years
Living in their own home
84%
81%
Steady at about 86%
Able to walk outdoors alone (with or without a stick)
68%
56%
Steady at about 63%
A year on, eight in ten were still living at home. What fell was the ability to get out and about. A hip fracture costs walking more often than it costs the home, which is why rehabilitation, and preventing the next fracture, matter so much.
2
Why a fracture can lead to lasting dependence
When it does happen, the fracture that matters most is at the top of the thigh bone: the hip fracture (大腿骨近位部骨折). Japan sees an estimated 190,000 or so each year (2017).
A fall
↓
Hip fracture — usually you cannot stand
↓
Admission and surgery
↓
Weeks of not moving normally
↓
Muscle strength falls; confidence falls further
↓
Walking may not return to what it was
The difficulty is not usually whether the bone heals. Surgery is good and bones unite. The hard part is recovering the strength and the confidence lost during the weeks of not moving.
Spinal fractures matter too when they add up. As the upper back rounds forward, the centre of balance shifts and falls become more likely. Breathing can become shallower and appetite can drop.
Falling is its own problem
Falls do damage even when nothing breaks. Once you have fallen, falling becomes frightening.
Going out feels like more effort, so you walk less. Strength and balance decline, and falls become more likely. People can shrink their own lives inside that loop without ever breaking a bone.
"I've been a bit reluctant to go out since I fell" is one of the most common things patients say. It is a normal human response, not a lack of courage. So the answer is practical adjustments rather than encouragement to be braver.
3
Fractures are not like dementia or stroke
Look at the ranking again. Dementia and frailty begin so gradually that no one can say when. Stroke arrives without warning on a single day.
Fractures differ in an important way.
A fracture has a definite day. So it also has a day before.
When it happens
What you can do beforehand
Dementia
Gradually, hard to notice
Limited
Stroke
Suddenly
Manage blood pressure, atrial fibrillation
Fracture
A specific, identifiable day
Strengthen bone; reduce the risk of falling
There is a second point too. A first fracture is a fairly reliable warning about the next one. In a study in Sado City, Niigata, spinal fractures occurred at an average age of 77.7 and hip fractures at 81.4. About eight in ten people with a hip fracture also had a spinal fracture.
Those years in between are when you can do the most. If osteoporosis treatment had begun when the spinal fracture appeared, things might have gone differently afterwards.
2. Do not let a fracture be filed under "bad luck"
If you have fractured before, check whether osteoporosis treatment was ever actually started. Treating the break and treating the disease are separate things, and the second is often missed.
Treating the fracture is repairing a broken wall. Treating osteoporosis is strengthening the building. Repair the wall and leave the structure weak, and the next tremor does the same damage again.
3. Start fall-proofing where you spend the most time
Most falls happen at home, and more happen in the ordinary living room than on the stairs or in the bathroom. Look at the familiar rooms, not just the obviously dangerous ones.
There is no need to push through pain or fear. But long periods of not moving make the next fall more likely. Within whatever range your doctor or physiotherapist advises, keep the habit of moving.
[!warning] Please note
Do not change or stop any prescribed medication on your own judgement. If something concerns you, speak to your doctor first.
If you have never had a bone density scan, ask at your next appointment. "I'd like to have my bone density checked" is enough to start.
If you have fractured before, check your medication list for a bone treatment. If there isn't one, raise it.
Look around the room you spend the most time in. Cables, a curled rug edge, things left in the walkway. One change today is plenty.
If someone in your family fractures, ask them whether their bones have been checked. They will be busy with the fracture itself, and it is easy for this to go unasked.
5
Summary and FAQ
Point
Detail
The ranking changed
In Japan's 2025 survey, fractures and falls became the second most common reason for needing long-term care (14.8%), overtaking stroke
Reading it correctly
About 15 in 100 people needing care got there via a fracture. It does not mean 15% of people who fracture will need care
Severity
Fractures appear at a similar rate at light and heavy care levels, so a fracture does not imply the severe end
The difference that matters
Unlike dementia and stroke, a fracture has an identifiable day, and so there is something you can do the day before
Direction over rank
Places two to four are within 0.4 points. Stroke is falling; fractures and falls are not
Frequently Asked Questions
Does this mean that if I fracture, I will need care?
No. The figure describes the share of people needing care whose route there began with a fracture or fall. Most people who fracture recover and carry on with their lives.
Dementia is number one — shouldn't I worry about that instead?
It is not a competition. But fractures differ in one useful way: there are specific, proven things to do in advance. There is a test, there are treatments, and there are ways to reduce falls. It makes sense to start where you can do the most.
I'm past 80. Is it too late to start treatment?
Age is not a reason to give up on treatment. Osteoporosis treatment has been shown to reduce fractures in older people too. Whenever you begin, the aim is to reduce the fractures that lie ahead of that point. Discuss what suits your situation with your doctor.
A relative has just been admitted with a hip fracture. What should I do?
Leave the fracture itself to the hospital. The useful thing you can do is ask, once, "will osteoporosis treatment be started?" Also find out where bone treatment will continue after discharge. That handover is the step that most often goes missing, and it is far easier to arrange during the admission than on discharge day.
Does the survey include people in care homes?
No. It is a household survey, so the figures describe people receiving care at home. Including people in care facilities could change the shares.
Is this the same for men?
Yes. Osteoporosis is more common in women, but men get it too. It is more often overlooked in men, and their outcomes after a hip fracture are reported to be worse.
Ministry of Health, Labour and Welfare, Japan. 2025 Comprehensive Survey of Living Conditions (令和7年 国民生活基礎調査), published 15 July 2026 — Table 12, main causes of long-term care need by care level.
Ministry of Health, Labour and Welfare, Japan. 2022 Comprehensive Survey of Living Conditions — Table 13.
Japan Osteoporosis Society, Japanese Society for Bone and Mineral Research, Japan Osteoporosis Foundation (eds). Guidelines for Prevention and Treatment of Osteoporosis, 2025 Edition. Life Science Publishing, 2025.
Tsuboi M, et al. Mortality and mobility after hip fracture in Japan: a ten-year follow-up. Journal of Bone and Joint Surgery (Br). 2007;89(4):461-466. PMID 17463112.
Sakuma M, et al. Incidence and outcome of osteoporotic fractures in 2004 in Sado City, Niigata Prefecture, Japan. Journal of Bone and Mineral Metabolism. 2008;26(4):373-378. PMID 18600404.
Takusari E, et al. Trends in hip fracture incidence in Japan: estimates based on nationwide hip fracture surveys from 1992 to 2017. JBMR Plus. 2021;5(2):e10428. PMID 33615101.
This article provides general medical information and is not intended as a substitute for professional medical advice. If you have concerns about preventing fractures or maintaining your independence, please consult your doctor.
