A patient came in last year after a small stumble on her front steps. Nothing dramatic. But she landed on her wrist and broke it. She was in her early sixties, active, no idea anything was wrong. That fracture was the first hint that her bones had been quietly thinning for years.
This is how osteoporosis usually announces itself: not with pain or warning, but with a break that shouldn't have happened from a fall that minor. That's why I bring it up before a patient ever has symptoms. By the time a bone breaks, we've missed the easy window. In my practice here in Los Angeles, screening for bone loss is one of the quiet wins of primary care.
What is osteoporosis, really?
Osteoporosis means your bones have lost density and become more fragile, so they break more easily. Your skeleton is living tissue. It's constantly being broken down and rebuilt. When the breakdown outpaces the rebuilding, bones get porous and weak.
The frustrating part is that you can't feel it happening. There's no ache, no stiffness, no signal. A bone can lose a good deal of its strength while you feel completely fine.
How do I know if I'm at risk for osteoporosis?
Your risk goes up with age, menopause, family history, certain medications, and a handful of conditions that affect how your body handles bone and minerals. Women lose bone faster after menopause because estrogen, which helps protect bone, drops off. But men get osteoporosis too, and it's underdiagnosed in them.
A few things I always ask about:
- Early menopause or a thin frame
- A parent who broke a hip
- Long-term steroid use, smoking, or heavy drinking
- Low vitamin D, which your bones need to absorb calcium
- An overactive thyroid or over-treated hypothyroidism, since too much thyroid hormone speeds bone loss
That last one surprises people. It's a good example of why I look at the whole picture rather than one number at a time.
When should I get a DEXA scan?
Most women should have their first bone density scan around age 65, and earlier if they have added risk factors. A DEXA scan is a quick, painless, low-radiation X-ray that measures the density of your hip and spine. It's the standard way we actually see how strong your bones are.
Men with risk factors and younger patients on long-term steroids may need one sooner. I coordinate the DEXA referral and walk through the results with you, because the number on the report only matters once we put it next to your history.
The scan gives us a T-score. Lower scores mean thinner bone. It also helps me estimate your fracture risk over the next several years, which is really the thing we care about.
What can I do to keep my bones strong?
A lot, actually, and most of it is everyday stuff. Weight-bearing movement like walking, light strength training, and balance work all signal your bones to hold onto density. Falls are the other half of the equation, so anything that keeps you steady on your feet matters.
On the nutrition side:
- Get enough calcium, ideally from food when you can
- Keep your vitamin D in a healthy range, which I check with a simple blood test
- Go easy on smoking and alcohol, both of which work against your bones
Here in LA we have an advantage with the sunshine, but plenty of my patients still run low on vitamin D, often because they're indoors more than they realize or wearing sunscreen daily (which is good for your skin). I'd rather measure it than guess.
What if my scan shows bone loss?
If your bones are already thin, we have effective treatments, and starting them can meaningfully lower your fracture risk. Sometimes the answer is targeted lifestyle changes and correcting a deficiency. Other times we add medication that slows bone breakdown or helps rebuild density.
I tailor that decision to you. Your age, your scan, your other health conditions, and frankly your preferences all go into it. Treatment isn't one-size-fits-all, and it isn't forever in every case. We reassess as we go.
What I don't want is for the first sign of trouble to be a broken hip. That's the thing I'm working to prevent.
If you're approaching menopause, have a family history of fractures, or just haven't had your bones checked and you're wondering whether you should, let's talk it through. I'm happy to look at your risk and figure out the right next step together. You can reach out here and we'll find a time.