Fracture Risk is the elephant in the room. Fractures can keep you from doing what you want for weeks or months. Fractures can put you in a Nursing Home, sometimes forever. Complications of fractures can kill you. Fractures are what you want to avoid if at all possible.
Increased Fracture Risk was defined as Clinical Osteoporosis by NIH in 2000. We may still think of Osteoporosis as a T-score of -2.5 on DXA. This is inaccurate. Fracture Risk increases with age and other factors at any given T-score. Over 80% of the persons who fracture have a T-score better than -2.5 !!! Accurately calculating your true Fracture Risk requires a Complete Bone Health Evaluation.
You can have a high Fracture Risk despite having a good Bone Mineral Density (BMD). Smoking is the biggest avoidable risk factor. Poorly controlled Diabetes stealthily weakens bones without decreasing BMD. Being Thin (especially a BMI less than 19) carries increased Fracture Risk.
Prednisone and Steroid Inhalers weaken bones and decrease BMD. So if you are on one of these, pre-emptively treat, or prepare for the side effects. Parents who fractured (especially a hip) or developed hump-back kyphosis (multiple vertebrae crumbling) are a major risk factor.
Mal-absorption of nutrients from Crohn’s, Colitis, Irritable Bowel Syndrome (IBS), Bariatric Surgery, Lactose intolerance, or Gluten intolerance, increase Fracture Risk.
And the biggest warning that you have increased Fracture Risk is having a fracture, any fracture.
If you have Increased Fracture Risk (Clinical Osteoporosis), you need to find out how to correct as many factors as you can. Then do it.
Jay Ginther, MD