The UTS Ageing Research Collaborative (UARC) kicked off its 2026 seminar series with a presentation by Distinguished Professor Tuan V Nguyen AM who challenged conventional approaches to hip fracture prevention and risk management by revisiting the Rose Paradox.
Balancing clinical care with prevention strategies
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Distinguished Professor Tuan V Nguyen AM presenting at the UARC seminar series
This population health theory from Geoffrey Rose states that a preventive measure bringing large benefits to a community often offers little to each participating individual.
Current clinical practice recommends prevention treatment for individuals diagnosed with osteoporosis as this classifies them as high-risk, an approach well supported by evidence.
However, Tuan’s work has shown that most hip fractures occur in people who are medium to low-risk and do not meet the diagnostic threshold for osteoporosis.
As a result, treating only individuals with osteoporosis, while important, cannot prevent a large proportion of hip fractures at the population level.
Understanding osteoporosis in the community
Tuan began his presentation by highlighting the significant burden of osteoporosis in the community. While approximately one in three women and one in five men will experience a fracture during their lifetime, the consequences can be severe.
“Hip fractures carry a mortality rate of 50 per cent within 12 months following the fracture, making them a major public health concern. Despite this, osteoporosis receives far less public attention than diseases such as breast cancer, even though the lifetime risk of hip fracture is comparable and the mortality rate is higher than breast cancer,” Tuan said.
Drawing on findings from his Dubbo Osteoporosis Epidemiology Study, Tuan then presented evidence in support of the Rose Paradox.
Comparing two generations of study participants recruited a decade apart, Tuan and his team found only a modest increase in average bone mineral density, approximately 5 per cent.
However, this small shift in bone health translated into a substantial reduction in osteoporosis prevalence. For women, the proportion classified as having osteoporosis fell from 28 per cent to 13 per cent, while in men it declined from 11 per cent to 6 per cent.
Hip fractures carry a mortality rate of 50 per cent within 12 months following the fracture, making them a major public health concern.
More significant was the impact on hip fractures. The incidence of hip fracture fell by 46 per cent in women and 61 per cent in men over the study period. These reductions were far greater than what would have been predicted from changes in bone density alone.
Importantly, most of the decline occurred among people who did not meet the clinical definition of osteoporosis. This reinforces a key point of the Rose Paradox that while individuals at moderate risk may experience only a small personal benefit from preventive measures, the cumulative effect across a large population can be substantial.
Reducing rates at the population level
Tuan argued that simple, low-cost interventions such as regular physical activity, adequate calcium and vitamin D intake, smoking and drinking cessation and healthier lifestyles have the potential to significantly reduce fracture rates at a population level.
While each intervention may offer only modest benefits to an individual, together they can shift the overall distribution of risk and prevent thousands of fractures.
"Prevention is better than treatment," Tuan concluded. "Rather than focusing only on a small high-risk group, we should consider how small improvements across the whole population can deliver much greater public health benefits."
While most osteoporosis care still prioritises identifying and treating high-risk individuals, Tuan believes the evidence increasingly supports a broader prevention focused approach, one that seeks to improve bone health across the entire community before fractures occur.
The seminar highlighted the importance of balancing individualised clinical care with broader prevention strategies and sparked discussion about how public health principles can be applied to improve bone health and healthy ageing outcomes.
Rather than focusing only on a small high-risk group, we should consider how small improvements across the whole population can deliver much greater public health benefits.
Co-founder and co-leader of UARC, Prof David Brown added, “One of the things I was thinking about is the economic consequences. You can model it at a system level and say you’ve got this intervention that prevents hip fracture which clearly is a good clinical health outcome. But when you can demonstrate the economic consequences of that, then it actually translates this into an investment opportunity for policymakers and for government.”
Looking forward, Tuan discussed the potential for a clinical trial in nursing homes to evaluate these interventions, with the aim of generating evidence that could inform policy and investment decisions. Beyond bone health, lifestyle modifications may also deliver wider benefits for cardiovascular health, dementia prevention and overall healthy ageing, reinforcing the value of population level approaches to improving health outcomes.
About Tuan’s work
“On the 26th of January 2022, exactly 40 years after Tuan landed in Australia as a refugee, wearing donated clothes and carrying nothing of his own, he received an Order of Australia,” David said.
In March this year Tuan also won the UTS Medal for Research Impact at the UTS Research Awards.
His success reflects his work revolutionising osteoporosis care by creating the Garvan Fracture Risk Calculator, the first tool using real-world data to predict 5 and 10-year fracture mortality risks, addressing gaps in traditional Bone Mineral Density testing.
On the 26th of January 2022, exactly 40 years after Tuan landed in Australia as a refugee, wearing donated clothes and carrying nothing of his own, he received an Order of Australia.
In 2023 he launched Bone Check, an AI-driven platform blending genetics, clinical, and lifestyle data to create personalised predictions now used in more than 165 countries.
Both these tools are endorsed by top organisations that cut hip fracture rates by 50% in case studies and have reshaped global diagnosis, risk assessment, and treatment.
Attend the next UARC seminar
The next seminar in the UARC seminar series will be on Wednesday 26 August, 1-2pm in RES Hub (CB02.05.250) and will feature Dr Kristina Chelberg.
Kristina will present on her research into inter-disciplinary qualitative approaches to examine how framings of dementia contribute to marginalisation of people living with dementia in legal responses to dementia aged care.
“Proximity is incredibly important between researchers over time, and so one of the things that we are trying to do at UARC is create proximity between our researchers,” David said.
“So not only learning about the specifics of the amazing work that our researchers are doing but also stimulating our thinking about how we can potentially collaborate and work together on the things that we have interest in, and skilling up.”
Come along to learn more. Fruit, tea and coffee will be provided.
When: Wednesday 26 August 2026, 1-2pm.
Where: RES Hub Event Space (CB02.05.250)
Registration details to come.
What’s next?
- Discover Tuan’s research.
- Discover Kristina’s research.
- Learn more about UARC.
- Connect with UARC via email to be informed about the next UARC Research Seminar.
- Read Tuan’s book Kangaroo Dreams: a memoir.