A cold and rainy day in California inspired me to write about this topic. It’s on days like these that I often find myself thinking about the patients I care for who are living with osteoporosis—because wet sidewalks, dim lighting, and slippery driveways can turn an ordinary moment into a dangerous one. For many people, a simple fall can mean a life-changing fracture. It’s one of the reasons I believe so strongly in being proactive and building a care plan that protects your independence, mobility, and quality of life.

Osteoporosis is more than low bone density—it's a chronic condition that increases fracture risk even with minor trauma. Common fracture sites include the spine, hip, and wrist. Most of the time, fractures occur with a fall, but can also occur with heavy lifting (these are compression fractures in the spine). Osteoporotic fractures do not typically occur spontaneously (like with day-to-day normal activities). Hip fractures, especially can significantly affect long-term health and independence, which is why prevention is priority number one.

Prevent Fractures Before They Happen:
6 Must-Know Osteoporosis Tips

Why Do Fractures Happen in Osteoporosis?

As humans, our peak bone density is when we are in our mid-20s. As we get older, bone remodeling slows down and bone loss begins to outpace bone formation. Postmenopausal estrogen changes accelerate that process. Many patients don’t realize they have osteoporosis until they experience a fracture, because the condition is often silent until something happens.

A rainy day might seem harmless, but slippery surfaces, reduced visibility, and indoor clutter become real hazards for someone with fragile bones.

  • Not always, but the risk can be significantly reduced. We can’t control every external factor, but we can address strength, balance, shoes, home setup, medications, and medical treatment. These are modifiable — and patients who focus on them see better outcomes.

  • Yes and No. Most osteoporotic fractures occur from falls. But compression fractures in the spine can happen with heavy lifting, bending forward incorrectly, or sudden force. What does not typically happen is a spontaneous fracture with no cause at all — daily gentle activities rarely cause fractures unless the bones are severely compromised.

Why is early evaluation and treatment important if I feel fine?

Early diagnosis and treatment are critical because this can help prevent fractures before they happen. Some people put off evaluation or treatment because they don’t feel sick. Osteoporosis itself is silent, but fractures can dramatically affect independence, mobility, and quality of life. Treating bone loss early gives you the best chance to stay active and maintain your lifestyle.

Yes, that does come up in our discussions. Some patients hesitate to start another prescription, especially if they already take medications for other conditions. However, the more you are informed about osteoporosis, the more it will make sense to initiate treatments when they are recommended for you. Understanding your fracture risk, bone density, and the benefits of therapy helps patients feel confident in taking steps to protect their bones and independence.

I’m also worried about taking more medications. Is that common?

Who Is Most at Risk of Osteoporosis?

People often wonder whether they fit into a “high-risk category”. Here are the most common risk factors:

  • Age over 50, especially postmenopausal women

  • Family history of osteoporosis

  • Smaller body frame

  • Long-term steroid use

  • Smoking or excessive alcohol intake

  • Low calcium or vitamin D

  • Sedentary lifestyle

  • Certain autoimmune diseases, including inflammatory arthritis

This is why I emphasize screening early. It’s much easier to prevent bone loss than it is to rebuild it later.

What Are the 6 Steps You Encourage Your Osteoporosis Patients to Take?

Here are the 6 steps I encourage all my osteoporosis patients to take. These don’t replace individualized care, but they are strong foundations for prevention

  • Exercises like tai chi, resistance training, and physical therapy programs help strengthen your legs and core while improving balance. If you are seeing a physical therapist to help with balance, ask them to teach you 5 exercises to strengthen your leg muscles (quads, hamstrings, glutes) and 5 exercises to work on your core. Make a set schedule to do these exercises (If first starting out, ‘start low and go slow’ is my motto) and remain consistent. Small, consistent improvements here significantly reduce fall risk.

    Strength training increases the muscle support around your bones. Even if your bone density doesn’t change dramatically, your fall risk decreases—often more than any medication alone can accomplish.

    What does “start low and go slow” actually look like?

    • Light hand weights or bands

    • Very short sets (5–8 reps)

    • Only a few exercises at first

    • Gradually increasing based on tolerance

    • Stpping if pain increases

    The key is consistency, not intensity.

    Do studies support this?
     Yes. I included an article in the newsletter: Resistance & Agility Training Lowers Fall Risk in Older Women with Low Bone Mass.
     Yes. One article in particular was a randomized, controlled trial of women aged 75–85 with low bone mass (osteopenia/osteoporosis), and concluded that twice-weekly resistance training reduced fall risk (measured via a physiological profile assessment) by ~57%, largely through improved postural stability.

    Liu-Ambrose T, Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc. 2004 May;52(5):657-65. doi: 10.1111/j.1532-5415.2004.52200.x. PMID: 15086643; PMCID: PMC3344816.

    Does strength training build bone?
     It can help slow bone loss — and in combination with weight-bearing exercise, it supports better remodeling. But its biggest benefit is fall prevention.

  • Simple adjustments can be lifesaving: removing loose rugs, adding grab bars in the bathroom, ensuring hallways are well-lit, and keeping frequently used items within easy reach.

    What changes make the biggest difference?

    • Nightlights in hallways and bathrooms

    • Non-slip mats in the shower

    • Replacing loose rugs

    • Organizing cluttered areas

    • Installing grab bars

    • Using rails on both sides of stairways

    • Keeping pet toys off the floor

    Should older adults avoid stepstools?

    Yes. It is not worth the risk.

  • Your shoes are your first line of defense against falls—make sure they’re sturdy, supportive, and slip-resistant.

     What types of shoes reduce fall risk the most?


    Look for:

    • A strong sole

    • A secure heel cup

    • Non-slip bottom

    • A wide toe box

    • Good traction

    Are soft slippers dangerous?
    Yes. They are unstable, slippery, and often the cause of bathroom or kitchen falls. I recommend structured indoor shoes instead.

    Do walking shoes help?
    Absolutely — especially those designed for stability.

  • Some medications—especially sedatives, sleep aids, and blood pressure drugs—can affect balance or cause dizziness. A medication review is an essential piece of fall prevention.

    Which medications tend to increase fall risk?

    • Sleep medications (Ambien, benzodiazepines)

    • Anxiety medications

    • Muscle relaxants

    • Blood pressure medications that drop pressure too fast

    • Pain medications that cause sedation

    • Certain antidepressants

     Should patients stop medications on their own?


    Never. Always discuss with your doctor — some medications have to be tapered slowly.

  • A DEXA scan helps us understand your fracture risk and whether you’re responding to treatment.

    How often should someone get a DEXA scan?

    • Every 1–2 years for people with osteoporosis

    What does a DEXA scan show?

    • T-scores (comparison to a young healthy adult) - this is for osteo

    • Z-scores (comparison to someone your own age)

    • Fracture risk (FRAX score)

    Whether bone density is stable, decreasing, or improving

  • There are excellent treatment options, from oral bisphosphonates to injectables (Prolia, Evenity) and anabolic therapies. These medications not only strengthen bones but also create meaningful reductions in fracture risk.

    Who should consider medication?

    • Anyone with a history of fracture

    • Anyone with a T-score ≤ -2.5

    • People with osteopenia AND high fracture risk

    • People on chronic steroids

    Is early treatment better?
     Yes — the earlier you stabilize or improve bone density, the more you reduce lifetime fracture risk.

Osteoporosis doesn’t have to get in the way of a full, active life. The earlier we recognize bone loss, the more options we have to protect your mobility and independence. On rainy days, I am reminded that sometimes prevention starts with the simplest things—good shoes, well-lit rooms, and a plan that is uniquely tailored to you.

What’s the best way to get started?


Begin with the basics:

  • Discuss symptoms and risks with your doctor

  • Get a DEXA scan

  • Start strength training gently

  • Evaluate your home

  • Look at your medications

  • Make sure you’re getting enough calcium and vitamin D

Small steps really do add up.

What’s the Bottom Line?

What If Someone Isn’t Sure Whether They’re at Risk?

If you or someone you love has osteoporosis—or if you’re not sure whether you’re at risk—this is a great time to start the conversation.

The hardest part is often the first step. But once you know your bone density and fall risk, you can create a personalized plan that fits your lifestyle.