Led by Professor Nicholas Harvey, Director, NIHR Biomedical Research Centre: Southampton, our researchers have driven new approaches to preventing weakening of bones (osteoporosis) and muscles (sarcopenia), changing UK and global health policy.

Key facts

• We were the first to show that pregnancy vitamin D supplementation improves offspring bone mass, informing underpinning mechanisms and new pregnancy guidelines

• Our researchers co-led the MRC-SCOOP trial, demonstrating that community fracture risk screening in older women prevents hip fractures

• Our expertise underpins the development of the next version of the internationally established FRAX fracture risk assessment tool

• Southampton research and leadership support international standards for Fracture Liaison Services

• Our science has discovered new molecular mechanisms informing potential nutritional interventions to improve muscle health

• Our research describing the human and economic costs of these conditions has informed guidelines and policy globally

Addressing bone and muscle health from before birth

Our research on vitamin D in pregnancy takes fracture prevention back to the womb. We were first to show a link between pregnant mothers’ vitamin D status and their babies’ bone mass. This informed 2014 Royal College of Obstetricians and Gynaecologists vitamin D in pregnancy guidelines.

Our MAVIDOS trial went on to show greater bone mass in winter babies born to mothers receiving vitamin D supplements (published here). Those results informed recommendations by the UK Scientific Advisory Committee on Nutrition, reflected in Public Health England maternal vitamin D guidance. Our subsequent work has demonstrated underlying mechanisms (published here and here) and sustained benefits for offspring bone mass into late childhood (published here).

In later life, building on our international work to define sarcopenia (SDOC, EWGSOP), we used human muscle samples to provide the first complete picture of molecular changes in sarcopenia across ethnicities. This revealed that impaired energy metabolism is of central importance in sarcopenia (published here), enabling us to target efforts in finding treatments (published here).

Preventing fractures through better early risk detection

In the MRC-SCOOP trial we addressed the burden of osteoporotic fracture through better risk management. It demonstrated a 28% reduction in hip fractures through systematic fracture risk screening (published here). The intervention was cost-effective (published here) and increase the use of osteoporosis medications (published here).

Those results drove major shifts in recommendations, supported by our current role in developing the second generation FRAX tool (published here). FRAX is the global standard for fracture risk assessment. It is central to 120 guidelines worldwide (published here).

International impact

We have led demonstration of the clinical- and cost-effectiveness of Fracture Liaison Services (FLS). This includes establishing the global standard of care through the International Osteoporosis Foundation (IOF) Capture the Fracture initiative. To date, it has supported over 1375 registered FLS across 66 countries. It was also a leading part of the 2020 global Consensus on Secondary Fracture Prevention.

In the UK, NHS-wide audit shows that over half of the population currently has access to the global FLS standard of care. Working with the Royal Osteoporosis Society and UK All Party Parliamentary Group in Osteoporosis, we are helping drive the achievement of the government commitment to universal UK FLS coverage by 2030.

Southampton research and leadership have driven many national and international guidelines. These include the 2024 UK National Osteoporosis Guideline Group recommendations (published here), 2024 ESCEO-IOF international guidelines for management of osteoporosis in men (published here), 2019 Europe-wide guidelines (ESCEO-IOF, published here), World Health Organization (WHO) 2026 hip fracture reporting standards (published here), WHO 2016 Report on Ageing and Health (published here), and WHO Minsk Declaration on the Lifecourse Approach (published here).