Frequently Asked Questions

Common questions about bone health, answered simply.

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Testing & Diagnosis

When should I get a bone density scan?

General guidelines:

• Women: at age 65, or earlier if risk factors present
• Men: at age 70, or earlier if risk factors present
• Anyone: after a fragility fracture, or if on long-term steroids

Risk factors that warrant earlier screening include: previous fracture, parent with hip fracture, low body weight, smoking, excessive alcohol, early menopause, or certain medical conditions.

How often should I repeat a DXA scan?

• Every 1-2 years if on treatment (to monitor response)
• Every 2 years for monitoring if not on treatment
• Your doctor may recommend different intervals based on your situation

What's the difference between a T-score and Z-score?

T-score: Compares you to a healthy young adult (peak bone mass). Used to diagnose osteoporosis.

Z-score: Compares you to people your own age and sex. Useful for identifying unexplained bone loss.

My T-score is -1.5. Should I be worried?

A T-score of -1.5 is in the osteopenia range (between -1 and -2.5). It's not osteoporosis, but it's a signal to:

• Optimize nutrition and exercise
• Check vitamin D
• Address any risk factors
• Monitor with repeat scans

Whether you need treatment depends on your overall fracture risk, not just the number.

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Nutrition

How much calcium do I actually need?

• Adults 19-50: 1,000 mg daily
• Women 51+ and men 71+: 1,200 mg daily
• Teens: 1,300 mg daily

Get it from food first. Only supplement if you can't meet needs through diet.

Should I take calcium supplements?

Only if you're not getting enough from food. And if you do:

• Don't exceed 500 mg per dose (absorption drops with larger amounts)
• Don't exceed 2,000-2,500 mg total daily
• Calcium citrate is better if you're on acid-reducing medications

How much vitamin D do I need?

Most adults need 1,000-2,000 IU daily to maintain optimal levels (30-70 ng/mL). Some need more. The only way to know is to test your blood level.

Can I get enough calcium without dairy?

Yes. Good non-dairy sources include:

• Fortified plant milks
• Sardines with bones
• Tofu (calcium-set)
• Leafy greens (kale, bok choy, collards)
• Fortified orange juice

Does coffee hurt my bones?

Moderate coffee (2-4 cups daily) has minimal impact if you get adequate calcium. Don't let coffee replace calcium-rich foods, but don't worry about reasonable consumption.

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Exercise

What's the best exercise for bones?

Most effective:

• Resistance training (weight lifting)
• High-impact activities (jumping, running, sports)

Less effective but still helpful:

• Hiking, dancing, tennis
• Moderate-impact activities

Minimal bone benefit:

• Walking (but still good for overall health)
• Swimming and cycling (great for fitness, not for bones)

I already have osteoporosis. Is it safe to exercise?

Yes, but with modifications:

• Avoid high-impact jumping
• Focus on resistance training (can be done safely)
• Prioritize balance exercises
• Consider working with a physical therapist
• Avoid exercises with forward spine flexion under load

How much exercise do I need?

For bone health:

• Strength training 2-3 times per week
• Include major muscle groups (legs, back, arms)
• Balance exercises, especially if over 60
• Some impact activity if bones can handle it

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Medications

Are bisphosphonates safe?

For people who need them, yes. The benefits (reduced fracture risk) far outweigh the risks for most patients. Rare side effects like jaw problems or atypical fractures are much less common than the fractures prevented.

How long should I take osteoporosis medication?

Depends on the drug and your risk level:

• Bisphosphonates: Often 3-5 years, then reassess (drug holidays are common)
• Denosumab: Ongoing (can't stop abruptly)
• Anabolic drugs: Limited duration (usually 1-2 years), then switch to antiresorptive

Can I stop taking denosumab?

Not without a plan. Stopping denosumab causes rapid bone loss and increased fracture risk. You must transition to another medication (usually a bisphosphonate) when stopping.

Why did my doctor say to take a bone-building drug first?

If you start with a bisphosphonate, it stays in your bones for years and blunts the response to anabolic (bone-building) drugs. Starting with the builder first gives better results.

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Hormones

Is HRT safe for bone health?

For most women starting within 10 years of menopause, the bone benefits of HRT are significant, and overall risk-benefit is often favorable. The key is timing—starting later (10+ years post-menopause) has a different risk profile.

Discuss your individual risk factors with a knowledgeable doctor.

Should men worry about estrogen?

Yes. Men convert testosterone to estrogen, and this estrogen is crucial for male bone health. Low estrogen in men (often from low testosterone) contributes to osteoporosis.

My testosterone is low. Will TRT help my bones?

Possibly. TRT can improve bone density in men with confirmed low testosterone, both directly and by providing more material for estrogen conversion. It requires proper evaluation and monitoring.

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Lifestyle

Does being thin increase my risk?

Yes. Very low body weight is a risk factor for osteoporosis because:

• Less mechanical stress on bones
• Lower estrogen production
• Often indicates inadequate nutrition

Some body fat is protective for bone health.

Does alcohol affect bones?

More than 2-3 drinks daily is harmful to bones. Moderate consumption (1 drink or less daily) doesn't appear to be a major concern.

Does smoking affect bones?

Yes. Smoking is a significant risk factor for osteoporosis. Quitting helps, though some damage may be permanent.

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Other Concerns

I broke a bone from a minor fall. What should I do?

Get a bone density scan. A fragility fracture (breaking a bone from minor trauma) is often the first sign of osteoporosis. Don't assume it was just bad luck.

My doctor says my bones are fine, but I'm losing height. Should I be concerned?

Yes. Height loss can indicate vertebral compression fractures, which are often painless. Ask for a vertebral fracture assessment or spine X-ray.

Can osteoporosis be reversed?

Bone density can be improved with treatment. The right medications can increase density by 5-15% or more. However, some structural damage (like lost trabecular connections) may be permanent, which is why prevention is better than treatment.

I'm young and was diagnosed with osteoporosis. What should I do?

Young people with osteoporosis need thorough investigation for underlying causes:

• Hormone levels (testosterone, estrogen, thyroid)
• Vitamin D and calcium
• Celiac disease screening
• Parathyroid function
• Review of medications and lifestyle factors

Don't accept "sometimes it just happens" without proper workup.