Molly Giles was standing in her kitchen one night, musing about whether to do the dishes or leave them until the morning, when a bone in her left leg snapped and she crashed to the ground, breaking her hip.

“I passed out, and I’m pretty sure I would have died if my partner hadn’t been there and called 911,” she said.

Giles, now 82, had “bones like meringue,” her doctor rather glibly later told her. A scan several years earlier had revealed osteopenia, a precursor to the “silent” disease of bone density loss known as osteoporosis. But neither Giles nor her doctors followed up, and her bones grew increasingly weak until her femur “melted,” as she later described it.

Giles isn’t alone in failing to take bone health seriously until a crisis. Weak bones can lead to sudden fractures that can disable or even kill you.

Some 20% to 30% of people who suffer a hip fracture die within a year, usually due to a downward spiral involving decreased mobility and possible infections. Nonetheless, experts say osteoporosis remains underdiagnosed, undertreated and widely misunderstood.

“It’s just not on the radar screens for many patients and physicians,” says Andrea Singer, director of bone densitometry at MedStar Georgetown University Hospital in Washington, D.C., and a spokeswoman for the Bone Health & Osteoporosis Foundation.

The neglect can endure even after a serious bone break, as a 2021 report from Milliman, a data firm, revealed.

Within six months of an osteoporosis-related fracture, the risk of a second break is highest, yet according to the Milliman report, only 8% of Medicare beneficiaries received a diagnostic bone density scan after a fracture. That share dropped to 5% for Black Medicare beneficiaries, and bone experts assume even worse rates for younger patients and those who haven’t had a fracture.

“When you come in to see your doctor, you may have 15 minutes, during which they’ll look at blood pressure, body weight and cholesterol, and then you may have a problem you want to discuss,” says endocrinologist and researcher Dolores Shoback at UCSF Health in San Francisco.