Osteoporosis, Bone Density, and Fragility Fracture Risk

Osteoporosis, Bone Density, and Fragility Fracture Risk in Princeton & Lawrenceville, NJ

Osteoporosis is a bone health condition where bones become weaker and more likely to break. It is often silent. Many people do not know they have low bone density until they have a fracture.

A fragility fracture is a broken bone from a low-energy event, such as a fall from standing height or a minor movement that would not normally break a healthy bone. Common fracture sites include the hip, spine, wrist, and shoulder.

Bone density testing can help identify osteoporosis or low bone mass before a fracture happens. The goal is not just to “get a number.” The goal is to understand fracture risk and create a practical plan for strength, balance, nutrition, medication decisions, fall prevention, and follow-up.

For patients in Princeton, Lawrenceville, West Windsor, Plainsboro, Hopewell, Pennington, Robbinsville, and nearby Mercer County communities, the goal is to identify who should be screened, who may need additional testing, and how to reduce fracture risk over time.

This page is educational. It can help you understand osteoporosis symptoms, risk factors, bone density testing, treatment options, and when to schedule an evaluation.

QUICK TAKEAWAYS

• Osteoporosis is often silent until a fracture occurs.
• Bone density testing is commonly done with a DXA scan.
• Screening is generally recommended for women age 65 and older, and for postmenopausal women younger than 65 who have increased fracture risk.
• Men can also develop osteoporosis, especially with age or risk factors, but screening decisions are more individualized.
• A low-trauma fracture should prompt a bone health evaluation.
• Prevention and treatment may include strength training, balance work, fall-risk reduction, adequate calcium, vitamin D, protein, medication review, and osteoporosis medication when appropriate.
• Supplements alone are not a full bone health plan.
• If you have had a low-trauma fracture, height loss, long-term steroid use, early menopause, eating disorder history, underfueling, or concern about bone density, schedule an evaluation with Princeton Sports and Family Medicine, P.C. or start here: Request Appointment.

WHO THIS AFFECTS + WHY IT HAPPENS

Who should think about osteoporosis risk?

Osteoporosis can affect women and men. Risk increases with age, but younger patients can also have low bone density due to medical conditions, medications, nutrition, hormonal factors, or underfueling.

People who may need a bone health discussion include:

• Women age 65 and older
• Postmenopausal women younger than 65 with risk factors
• Men with risk factors for low bone density
• Adults with a low-trauma fracture
• Adults with height loss or new spinal curvature
• Adults with long-term steroid use
• People with early menopause
• People with low body weight
• People with eating disorder history
• Athletes with underfueling or RED-S concerns
• People with low vitamin D or poor calcium intake
• People with limited weight-bearing activity
• People with smoking or heavy alcohol use
• People with thyroid, parathyroid, kidney, liver, gastrointestinal, or inflammatory conditions
• People taking medications that may affect bone health
• Adults with frequent falls or balance problems

Why osteoporosis happens

Bone is living tissue. It is constantly being broken down and rebuilt. Osteoporosis develops when bone loss outpaces bone building or when bone structure weakens.

Contributors may include:

• Aging
• Menopause and lower estrogen levels
• Family history of hip fracture or osteoporosis
• Low body weight
• Low calcium intake
• Low vitamin D
• Low protein intake
• Inactivity
• Smoking
• Heavy alcohol use
• Long-term glucocorticoid steroid use
• Certain seizure medications
• Certain cancer treatments
• Thyroid or parathyroid disorders
• Gastrointestinal conditions that affect absorption
• Kidney disease
• Rheumatoid arthritis and other inflammatory conditions
• Underfueling or Relative Energy Deficiency in Sport
• Recurrent falls or poor balance

For many patients, osteoporosis risk comes from more than one factor. That is why evaluation should include more than just the bone density result.

1. E) SYMPTOMS + WHAT’S NORMAL VS NOT

Common symptoms

Osteoporosis usually does not cause pain by itself until a fracture occurs.

Possible clues include:

• Low-trauma fracture
• Wrist fracture after a minor fall
• Hip fracture after a fall from standing height
• Spine compression fracture
• Sudden back pain after bending, lifting, coughing, or minor trauma
• Height loss
• New stooped posture
• Recurrent stress injuries
• Bone density test showing low bone mass or osteoporosis

Many patients feel normal until a fracture happens.

Fragility fracture warning signs

A fragility fracture may occur from:

• A fall from standing height
• A minor trip
• Bending or lifting
• Coughing or sneezing in severe cases
• A low-energy event that would not usually break a healthy bone

A low-trauma fracture is a major signal to assess bone health.

What can be monitored briefly

General concern about future bone health can usually be discussed at a scheduled preventive visit. It does not require urgent care unless there is an acute injury or red flag.

Helpful steps while awaiting a visit may include:

• Listing prior fractures
• Gathering prior DXA reports
• Reviewing current medications
• Reviewing calcium, vitamin D, protein, and exercise habits
• Not starting high-dose supplements without guidance
• Avoiding new high-risk activity if balance or fracture risk is a concern
• Scheduling evaluation if there has been a low-trauma fracture

Schedule a visit if…

A scheduled evaluation is appropriate if:

• You are due for bone density screening
• You had a fracture from a minor fall or low-energy injury
• You have height loss or new back curvature
• You have new or unexplained mid-back or low-back pain
• You have long-term steroid use
• You have early menopause or irregular periods
• You have low body weight or eating disorder history
• You have RED-S or underfueling concerns
• You have a family history of hip fracture
• You smoke or drink alcohol heavily
• You have thyroid, parathyroid, kidney, liver, gastrointestinal, or inflammatory disease
• You want help interpreting a DXA scan
• You were told you have osteopenia or osteoporosis
• You want a fracture prevention plan

Seek urgent care now if…

Seek urgent or prompt medical evaluation if you have:

• Severe pain after a fall
• Inability to bear weight
• Suspected hip fracture
• New severe back pain after minor trauma
• New weakness, numbness, or loss of bowel/bladder control
• Spine pain with fever or cancer history
• Visible deformity after injury
• Head injury or loss of consciousness after a fall
• Severe pain that is rapidly worsening
• Chest pain, shortness of breath, or fainting with a fall

Osteoporosis itself is usually not an emergency, but fractures and neurologic symptoms can be.

DIAGNOSIS

Osteoporosis evaluation includes risk review, fracture history, bone density testing when appropriate, and sometimes lab testing to look for secondary causes.

What history matters?

Your clinician may ask:

• Age and menopausal status
• Prior fractures and how they happened
• Family history of osteoporosis or hip fracture
• Height loss
• Back pain or spine fracture history
• Fall history
• Balance concerns
• Smoking history
• Alcohol use
• Nutrition habits
• Calcium, vitamin D, and protein intake
• Exercise and strength training habits
• Menstrual history when relevant
• Eating disorder or underfueling history
• Steroid medication history
• Thyroid, parathyroid, kidney, liver, gastrointestinal, or inflammatory disease history
• Medication and supplement list
• Prior DXA scan results
• Prior osteoporosis medication use

Bone density testing

A bone density test measures bone mineral density. The most common test is a DXA scan.

A DXA scan usually measures:

• Hip bone density
• Spine bone density
• Sometimes forearm bone density

The report may include:

• T-score: compares bone density with a young healthy adult reference group. This is commonly used to diagnose osteopenia or osteoporosis in postmenopausal women and men over 50.
• Z-score: compares bone density with people of similar age and sex. This is often more useful in younger patients.

Bone density is important, but fracture risk is not based on bone density alone. Age, prior fracture, fall risk, medications, family history, and other risk factors also matter.

FRAX and fracture risk

FRAX is a fracture risk calculator used in many settings. It estimates 10-year fracture risk based on age, sex, body size, prior fracture, parent hip fracture, smoking, steroid use, rheumatoid arthritis, alcohol use, and bone density when available.

FRAX can help guide decisions, but it has limitations. It does not capture every risk factor equally, and clinical judgment still matters.

Lab testing

Lab testing may be considered to look for contributors to bone loss.

Testing may include:

• Calcium
• Vitamin D
• Kidney function
• Liver function
• Thyroid testing
• Parathyroid hormone when appropriate
• Blood count
• Celiac testing when appropriate
• Testosterone testing in selected men
• Markers related to inflammation or other conditions when indicated

Testing should be individualized. Not everyone needs the same lab panel.

Imaging for fracture concern

X-rays or other imaging may be considered if there is concern for:

• Vertebral compression fracture
• Hip fracture
• Wrist fracture
• Stress fracture
• Pain after a fall
• Height loss or spine curvature
• Persistent focal bone pain

TREATMENT OPTIONS

Treatment depends on fracture risk, bone density, age, prior fracture, medical history, medications, and patient goals.

Lifestyle foundations

Bone health care usually starts with the basics:

• Weight-bearing activity
• Resistance training
• Balance training
• Fall-risk reduction
• Adequate protein
• Adequate calcium
• Adequate vitamin D
• Tobacco avoidance
• Alcohol moderation
• Sleep and recovery
• Managing chronic medical conditions

These steps are important whether or not medication is used.

Strength and balance training

Exercise is one of the most important parts of fracture prevention.

A plan may include:

• Progressive resistance training
• Weight-bearing activity such as walking
• Hip and leg strengthening
• Posture and back extensor strengthening
• Balance work
• Gait training when needed
• Safe lifting mechanics
• Fall-prevention strategies
• Gradual progression for people who are deconditioned or fearful of falling

Exercise should be safe for the person’s fracture risk. Some people with spine osteoporosis or compression fractures may need to avoid loaded spinal flexion, aggressive twisting, or high-impact activity unless cleared.

Nutrition

Bone-supportive nutrition may include:

• Adequate protein
• Calcium-rich foods
• Vitamin D support
• Fruits and vegetables
• Avoiding severe calorie restriction
• Treating underfueling
• Reviewing supplements
• Addressing gastrointestinal conditions that affect absorption

Calcium and vitamin D are important, but more is not always better. Supplement plans should be individualized.

Medication review

Some medications can affect bone health or fall risk.

Medication review may include:

• Long-term steroid exposure
• Certain seizure medications
• Acid-suppressing medications
• Some cancer treatments
• Some diabetes medications
• Sedating medications that increase fall risk
• Thyroid medication dose if over-replaced
• Supplements that may interact with other medications

Do not stop prescribed medications without clinician guidance. The goal is to understand risk and adjust safely when appropriate.

Osteoporosis medications

Medication may be recommended for patients with osteoporosis, prior fragility fracture, or elevated fracture risk.

Options may include:

• Bisphosphonates
• Denosumab
• Selective estrogen receptor modulators in selected patients
• Hormone-related therapy in selected patients
• Anabolic bone-building medications for selected higher-risk patients
• Other medications based on risk and specialist guidance

Medication choice depends on:

• Fracture history
• Bone density
• Kidney function
• GI history
• Dental and jaw risk factors
• Age and sex
• Menopause history
• Pregnancy potential when relevant
• Other medications
• Patient preferences
• Severity of fracture risk

Patients on osteoporosis medication need follow-up to monitor response, side effects, duration, and whether therapy should continue or change.

Fall prevention

Fracture prevention is not only about bone density. Falls matter.

Fall prevention may include:

• Vision check
• Footwear review
• Balance training
• Strength training
• Home safety changes
• Medication review
• Treating dizziness or neuropathy
• Assistive devices when appropriate
• Managing blood pressure drops
• Addressing sleep medications or sedatives

A strong bone plan should also be a fall prevention plan.

Referral

Referral may be appropriate when:

• Osteoporosis is severe
• Multiple fragility fractures occurred
• A fracture occurs despite treatment
• Bone density is very low
• Secondary causes are suspected
• Kidney disease complicates medication choice
• Lab abnormalities are present
• Complex medication decisions are needed
• Younger patient has unexplained low bone density
• Men have low bone density without a clear explanation

Referral may include endocrinology, rheumatology, orthopedics, or another specialist depending on the situation.

RETURN TO ACTIVITY / EXERCISE GUIDANCE

Exercise is important for bone health, but the right plan depends on fracture risk, current fitness, pain, balance, and prior fracture history.

If you have low bone density but no fracture

Goals:

• Build strength
• Improve balance
• Maintain mobility
• Reduce fall risk
• Preserve independence
• Support long-term bone health

Often helpful:

• Walking
• Strength training
• Step-ups
• Squats within safe range
• Hip strengthening
• Core and posture work
• Balance training
• Progressive resistance exercises

Progress slowly if you are new to strength training.

If you have osteoporosis or prior spine fracture

Exercise may need modification.

Be cautious with:

• Loaded spinal flexion
• Repeated sit-ups or crunches
• Heavy twisting
• High-impact exercise without clearance
• Rapid changes in direction if balance is poor
• Heavy lifting without technique guidance

Often helpful:

• Neutral-spine strength work
• Hip and leg strengthening
• Back extensor strengthening
• Balance and fall-prevention training
• Walking
• Supervised physical therapy when needed

After a fragility fracture

Return depends on the fracture site, healing, pain, and specialist guidance.

Priorities include:

• Pain control
• Fracture healing
• Safe mobility
• Fall prevention
• Strength recovery
• Bone health evaluation
• Prevention of another fracture

A low-trauma fracture should not be treated as a one-time accident without asking why it happened.

Athletes and active adults

Bone health concerns in athletes may involve:

• Stress fractures
• Recurrent bone stress injuries
• Low energy availability
• RED-S
• Irregular or absent menstrual cycles
• Low body weight
• Poor recovery
• Low vitamin D
• Inadequate calcium or protein
• Rapid training increases

Return to sport should address both the injury and the reason the bone became vulnerable.

Common mistakes

• Waiting for a fracture before checking bone health
• Assuming osteoporosis causes pain before a fracture
• Taking supplements without addressing strength, balance, and fall risk
• Stopping activity out of fear
• Doing aggressive high-impact exercise without guidance
• Ignoring height loss or new spine curvature
• Treating a fragility fracture without evaluating bone density
• Missing underfueling or RED-S in athletes
• Assuming men cannot get osteoporosis
• Interpreting a DXA result without considering total fracture risk

PREVENTION

Bone health prevention starts early and continues across the lifespan.

Helpful steps include:

• Regular weight-bearing activity
• Progressive resistance training
• Balance training
• Adequate protein intake
• Calcium-rich foods
• Vitamin D assessment when appropriate
• Avoiding smoking
• Limiting heavy alcohol intake
• Avoiding severe calorie restriction
• Treating underfueling
• Managing thyroid and other endocrine conditions
• Reviewing medications that affect bone health
• Fall prevention for older adults
• Screening when age or risk factors indicate
• Follow-up after low-trauma fracture
• Monitoring bone density when appropriate

For many patients, the best prevention plan combines medical screening with strength, nutrition, and practical fall-risk reduction.

HOW PSFM CAN HELP

At Princeton Sports and Family Medicine, P.C., we evaluate bone health by looking at the whole picture: fracture history, risk factors, medications, nutrition, strength, balance, fall risk, and bone density testing when appropriate.

A visit may include review of prior fractures, DXA reports, medications, family history, menopause history, nutrition, exercise habits, and medical conditions that affect bone health. We can help decide whether bone density testing, lab evaluation, imaging, medication discussion, physical therapy, or specialist referral should be considered.

For patients with osteopenia, osteoporosis, or fragility fracture risk, care may include a prevention plan, strength and balance recommendations, calcium/vitamin D guidance, fall-risk reduction, medication discussion, and follow-up planning.

For athletes and active adults, we can also help evaluate bone stress injuries, underfueling, RED-S concerns, training-load issues, and safe return to activity.

Depending on the situation, care may involve Primary Care Services, Sports Medicine Services, and coordination with Physical Therapy Services when strength, balance, gait, or fall prevention are part of the plan.

Schedule an evaluation with Princeton Sports and Family Medicine, P.C. in Lawrenceville, NJ, or start here: Request Appointment.

FAQs

What is osteoporosis?

Osteoporosis is a condition where bones become weaker and more likely to break. It often has no symptoms until a fracture occurs.

What is osteopenia?

Osteopenia means bone density is lower than normal but not low enough to meet the definition of osteoporosis. It still may increase fracture risk depending on age and other risk factors.

What is a fragility fracture?

A fragility fracture is a broken bone from a low-energy event, such as a fall from standing height or lower. It may be a sign of osteoporosis or elevated fracture risk.

Who should get a bone density test?

Women age 65 and older are generally recommended for screening. Postmenopausal women younger than 65 may need screening if they have increased risk. Men may also need individualized screening based on risk factors.

What is a DXA scan?

A DXA scan is a bone density test that measures bone mineral density, usually at the hip and spine. It helps diagnose osteopenia or osteoporosis and estimate fracture risk.

Does osteoporosis cause pain?

Osteoporosis itself usually does not cause pain unless a fracture occurs. Spine compression fractures can cause sudden back pain, height loss, or stooped posture.

Can men get osteoporosis?

Yes. Men can develop osteoporosis, especially with age, low testosterone, steroid use, heavy alcohol use, smoking, certain medications, or medical conditions that affect bone health.

Are calcium and vitamin D enough?

Calcium and vitamin D are important, but they are not a complete plan. Bone health also depends on strength training, balance, fall prevention, protein, medication review, medical conditions, and sometimes osteoporosis medication.

What should I do after a low-trauma fracture?

A low-trauma fracture should prompt a bone health evaluation. This may include DXA testing, lab evaluation, medication review, fall-risk assessment, and prevention planning.

Do you evaluate osteoporosis and bone density concerns near Princeton and Lawrenceville?

Yes. Princeton Sports and Family Medicine, P.C. evaluates osteoporosis risk, bone density concerns, fragility fracture risk, and bone health questions for patients from Princeton, Lawrenceville, West Windsor, Plainsboro, Hopewell, Pennington, Robbinsville, and nearby Mercer County communities.

RELATED CONDITIONS

Patients with osteoporosis, low bone density, or fragility fracture concerns may also want to learn about:

• Annual Physical
• Preventive Care
• Women’s Health
• Stress Fracture
• Foot Stress Fracture
• Relative Energy Deficiency in Sport / Underfueling
• Hypothyroidism / Thyroid Problems

Because bone density, fracture risk, hormone changes, thyroid disease, underfueling, nutrition, medication history, and fall risk can overlap, a focused evaluation can help identify the most useful next step.

RELATED PSFM SERVICES

• Primary Care Services
• Sports Medicine Services
• Physical Therapy Services

Osteoporosis is often silent until a fracture occurs. That makes screening, risk assessment, and prevention important. A bone density result is useful, but the bigger question is how to reduce fracture risk in a way that fits your age, health, activity level, nutrition, medications, and goals.

You do not need to guess whether you need a DXA scan, lab testing, medication, strength training, balance work, fall prevention, or specialist referral. A focused evaluation can help clarify the next step.

Schedule an evaluation with Princeton Sports and Family Medicine, P.C. in Lawrenceville, NJ, or start here: Request Appointment.

MEDICAL DISCLAIMER

This page is for general education and does not replace medical advice. Symptoms can have more than one cause. If you have severe symptoms, rapidly worsening pain, chest pain, shortness of breath, one-sided weakness, uncontrolled bleeding, signs of serious infection, inability to bear weight after injury, new neurologic symptoms, severe back pain after trauma, or any urgent concern, seek immediate medical evaluation.