“My bones are crumbling — am I going to end up in a wheelchair?”

A T-score ≤−2.5 is osteoporosis, and a low-trauma (fragility) fracture plus a high FRAX places this patient firmly in the treat category (NICE NG259 risk assessment; NOGG 2024 thresholds; NICE TA464) — the goal is preventing the next, more serious fracture (hip/spine). The first task is accurate reframing: osteoporosis is reduced bone density and increased fracture risk — treatable and modifiable — NOT "crumbling" or inevitable disability, the catastrophic picture night-time googling produces. The second is honest, balanced bisphosphonate information: the feared harms (osteonecrosis of the jaw, atypical femoral fracture) are very rare and dose/context-dependent (MHRA Drug Safety Update, July 2015 and June 2011), while the fracture-prevention benefit is substantial; common GI effects are manageable with correct administration. Add the full package — calcium/vitamin D, weight-bearing/resistance exercise, smoking/alcohol, falls prevention, dental check — and offer alternatives if declined/not tolerated. The examinable hidden agenda is the mother who fractured a hip, went to a home and died within a year; treatment plus falls prevention is precisely how she AVOIDS that fate. Reframe with warmth, give real numbers, and support an informed, shared decision rather than steam-rollering or accepting a scare-story refusal.