Abstract Summary There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complexpsychosocialfactors,havingaprofoundimpactonphysical function/activity which accumulates over time. More information is required on how treatments impact physical function. Introduction There is increasing need to understand patientcentred outcomes in osteoporosis (OP) clinical research and