Bone health and osteoporosis: preventing the fracture that changes daily life

The short answer: Osteoporosis weakens bones and may cause no symptoms before a fracture. Screening can identify risk, but the goal is to prevent broken bones and preserve function. A fracture from a minor fall deserves follow-up even if the initial injury has healed. MC35 MC36 MC37

Who should have a bone-density test?

The USPSTF's January 2025 recommendation supports osteoporosis screening for women aged 65 and older. For postmenopausal women younger than 65, clinicians first identify risk factors and use clinical risk assessment to decide whether screening is indicated. A central DXA scan measures bone density, usually at the hip and spine. MC35

These screening recommendations do not cover every situation. A prior fragility fracture, known osteoporosis, long-term steroid treatment, or a condition causing secondary bone loss can require evaluation outside the routine screening pathway. Do not wait until age 65 if you already have a relevant problem. MC35

The scan is one part of the decision

A DXA result helps estimate fracture risk. Your age, fracture history, medicines, falls, and other conditions also matter. A scan should lead to a discussion you understand: what the result means, whether treatment is recommended, and when follow-up is needed. MC36

Tell the clinician about height loss, new back pain, previous wrist or hip fractures, menopause occurring early, and any prolonged steroid use. Bring the actual report if a scan was done elsewhere. Comparing reports is more helpful when the dates, measurement sites, and testing center are known.

When to seek prompt care

Get urgent assessment for severe pain after a fall, inability to bear weight, new deformity, or a possible hip fracture. A head injury may need urgent evaluation, especially if you take a blood thinner. New severe back pain after a minor strain can also warrant assessment. A person who cannot get up safely should call for help rather than repeatedly trying alone. MC39

Do not minimize a fall because it happened at home or because you feel embarrassed. Understanding how it happened can identify a preventable hazard or a medication problem.

Medicines can lower fracture risk

Bisphosphonates are often an initial choice for appropriate postmenopausal patients at high fracture risk. Other options include denosumab and bone-building treatments for selected patients at very high risk. Choice depends on fracture risk, kidney health, other conditions, and the ability to follow the treatment schedule. MC37

Ask what benefit the medicine is expected to provide and how it is taken or administered. Explain any swallowing difficulty, dental treatment plans, transportation barriers, or medication side effects. An appointment for an infusion or injection requires the same follow-through as a daily pill.

A crucial distinction: not every bone medicine has a “holiday”

After several years, some patients taking a bisphosphonate may qualify for a supervised treatment pause. Denosumab is different: delaying or stopping it without a follow-on plan can lead to rapid bone loss and fractures. Contact the prescribing office before a scheduled dose is missed. MC37

FDA also added a boxed warning for severe low blood calcium with denosumab in patients with advanced chronic kidney disease, especially those on dialysis. Those patients need specialist assessment and appropriate monitoring. Do not abruptly stop an existing treatment because of a headline; obtain an individualized continuation or transition plan. MC38

Nutrition supports treatment but does not replace it

Adequate calcium, vitamin D, protein, and overall food intake support bone and muscle health. Supplements may be useful when diet or an identified deficiency makes them necessary, but more is not automatically better. Kidney disease and other conditions can change what is appropriate. MC36 MC53

Ask for a review of what you actually eat and take. If you already use several supplements, bring the bottles so the clinician can see overlapping ingredients. If dentures, appetite, nausea, finances, or swallowing make eating difficult, that problem deserves its own plan.

Strength, balance, and the home environment matter

Fall prevention includes activity adapted to your abilities, strength and balance work, appropriate footwear, vision and hearing care, and reviewing medicines that cause dizziness or sedation. Removing loose rugs, improving night lighting, and adding grab bars can reduce hazards. MC39 MC40

A physical therapist can help when you are afraid of falling, have had repeated falls, or need advice about safe movement with osteoporosis. Tell the therapist about prior fractures. A useful exercise program should improve function without exposing you to inappropriate strain. MC36

Questions for the next visit

• Do I need a DXA scan or evaluation because of a previous fracture?
• What is my fracture risk, and what would treatment change?
• Which medicine fits my kidneys, other conditions, and daily life?
• If I miss an injection or need to stop a medicine, whom should I call?
• Could any of my medicines or home conditions be increasing falls?
• Would physical therapy or a nutrition visit help?