Questions to Ask Your Doctor After an Osteoporosis Diagnosis

About Nicole Pajer

Nicole Pajer is a Los Angeles-based freelance published in The New York Times, Woman's Day, AARP, Parade, Wired, Glamour, People and more.

An osteoporosis diagnosis can feel overwhelming. And it’s completely normal to leave your doctor’s office with more questions than answers. Learning more about your diagnosis and what that means for your bone health going forward can help you feel more prepared for your next conversation with your provider.

Before your next appointment, write down a list of questions to make sure you get answers to. This can help you feel more empowered going into treatment and clarify everything from what you can be doing at home to help manage your condition to what your treatment options may look like.

Not sure what questions to ask? Here are 10 to add to your list.

1. How serious is my osteoporosis?

Dr. Shannon Carpenter, a board-certified orthopedic surgeon with The Bone Health Clinic in Kansas City, calls osteoporosis a disease that "weakens bones silently," raising your risk of a break. Symptoms don’t often occur until a patient breaks a bone. So the first step is to understand how severe your osteoporosis is and what it means for your fracture risk. “A simple bone density test called a DXA can help your doctor assess the severity of your osteoporosis and how high your risk of breaking a bone is,” says Carpenter. Your doctor can walk you through your DXA results and explain how they factor into your overall fracture risk. DXA results are interpreted alongside factors such as age, prior fractures, falls, medications and other health conditions. When appropriate, a tool such as FRAX may be used to estimate 10-year fracture risk.

2. What caused my osteoporosis?

Some degree of bone loss is a normal part of aging. But other things can cause it to accelerate. “We reach peak bone mass around age 30. After menopause, estrogen loss can cause your body to lose more bone than it creates, resulting in weaker bones that can result in fractures,” Carpenter says.

Genetics and lifestyle factors can contribute as well. Carpenter notes that a sedentary lifestyle, smoking and alcohol use can all play a role. Your doctor may also want to investigate whether other medical conditions or medications are contributing to your bone loss. Carpenter recommends a full blood work-up with a new osteoporosis diagnosis to help rule out any underlying causes. The laboratory evaluation should be individualized and may include blood calcium, vitamin D, thyroid and parathyroid testing, with other tests based on your history and risk factors.

3. What's my risk of breaking a bone?

When it comes to the strength of your bones, your bone density number is only part of the story. Your doctor will also look at your history and your health overall. "Your DXA results, along with other factors like family history of osteoporosis or low body weight, can help your doctor determine your fracture risk level," Carpenter says.

It’s important to tell your doctor about every broken bone you've had, even ones that seemed minor at the time. A fracture after age 50 from a fall at standing height or less may be a fragility fracture and should prompt evaluation. Whether your overall fracture risk is high or very high depends on factors such as the fracture site, timing, number of fractures and other clinical risks. Ask your doctor where you fall on the risk spectrum and what that means for your next steps.

4. Do I need medication?

This depends on factors like the severity of your condition and your history of broken bones. Depending on your fracture risk, your healthcare provider may recommend medication in addition to exercise and lifestyle changes.

“For some women, diet and exercise alone won't be enough to reduce the risk of fractures,” says Carpenter. Ask your doctor for their assessment on whether you need medication and what type may be right for you.

5. What are my treatment options?

Osteoporosis treatments have come a long way. “Many newly diagnosed patients assume the best we can do is slow bone loss, but there are also therapies, called anabolics, that help build new bone,” Carpenter says. Ask your doctor about the benefits and potential risks of the treatments you're considering and have them explain why they are recommending one option over another based on your individual fracture risk and health history.

You will also want to ask how long you may need treatment. Carpenter says patients frequently worry that an osteoporosis diagnosis means they'll need medication for the rest of their lives. While osteoporosis is a lifelong condition, your medication plan may change over time depending on your response to treatment. Treatment can come in the form of pills, injections or intravenous infusions, with dosing schedules that vary depending on the medication. Ask how treatment would eventually be stopped or changed. Denosumab should not be delayed or stopped without a plan for follow-on therapy because bone loss and fracture risk can rise quickly after it is discontinued.

6. Should I be taking calcium and vitamin D?

Calcium and vitamin D play important roles in maintaining bone health, but just because you have osteoporosis doesn’t necessarily mean you should start taking high-dose supplements on your own. “Calcium and vitamin D supplements and physical activity can support bone health, but they may not be adequate to reduce fracture risk,” Carpenter says. She recommends getting calcium from your diet when possible and making sure you're getting adequate vitamin D. Ask your doctor how much of each you need, whether you're getting enough through your diet and whether a supplement makes sense for you.

It’s important to remember that supplements are only one part of osteoporosis management. “Supplements, diet and exercise may not be adequate to reduce fracture risk,” Carpenter says. Calcium and vitamin D are generally used as adjuncts — not substitutes for osteoporosis medication when medication is indicated.

7. What kind of exercise should I be doing?

Being diagnosed with osteoporosis may make you hesitant to want to exercise, but being active can help strengthen muscles and reduce your risk of falling. “Many women are afraid to exercise after an osteoporosis diagnosis, but that's often when your body needs it most,” Carpenter says. “To reduce the risk of fractures, you need to strengthen your bones and prevent falls, and exercise is one of the best ways to do both.”

Engaging in weight-bearing activity and strength training may be beneficial. However, it’s important to ask your doctor what exercises are right for you depending on factors such as your current fitness level and fracture history. It can also be helpful to ask what activities to avoid and whether they recommend working with a physical therapist or other trainer to get started. High-impact activity and repeated forward bending or twisting may be unsafe for some people, especially those with vertebral fractures or very low bone density, so ask whether a physical therapist should tailor your program.

8. What can I do to prevent falls?

When bones are fragile, preventing falls becomes particularly important. Ask your doctor for tips and strategies to reduce your risk of falling. This can involve clearing clutter off the floor, making sure railings on staircases are stable, keeping your porch well lit, using a shoulder bag to keep your hands free and using a walker or cane as needed. Balance training and exercises like tai chi may also help.

9. Do I need any additional tests?

A DXA scan tells you about your bone density, but it may not tell the whole story. Carpenter recommends asking whether you need blood work to look for other health issues that could be contributing to bone loss, such as vitamin D deficiency or thyroid or parathyroid problems.

You can also ask your provider about a trabecular bone score (TBS). TBS is calculated from lumbar spine DXA images and may add information about bone texture and fracture risk, but it does not replace bone-density results or the broader clinical assessment.

It may also be worth asking if you should have your muscle mass or strength evaluated. That’s because weak muscles can increase your risk of falling, and falls can lead to fractures.

10. How will we know if my treatment is working?

Osteoporosis is a condition that requires ongoing management to make sure your treatment is working. Ask your doctor how they plan to monitor your progress and when you should have another DXA scan. “You can't optimize what you haven't measured,” Carpenter says. Repeat DXA scans are an important way to help your doctor determine whether your bone density is continuing to decline or improving with treatment. The timing of repeat DXA scans should be individualized. The Endocrine Society suggests monitoring bone density every one to three years for high-risk patients receiving treatment, while ISCD advises repeating a scan when the result is likely to influence care.

Your bone density numbers aren't the only measure of how well a treatment is working. Doctors also consider whether you have had a new fracture, whether you are taking medication as prescribed and whether your overall fracture risk has changed. A new fracture or an unexpected decline in bone density may prompt a reassessment of your treatment plan.

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