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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Endocrinology

Living Well with Osteoporosis: Monitoring and Safety

At a Glance

Living with osteoporosis requires a long-term focus on fall prevention, safe exercise, and regular DXA scan monitoring. While long-term bone medications carry rare side effects, their benefits in preventing serious fractures far outweigh the risks.

Living with osteoporosis means adopting a mindset of “long-term maintenance.” Once you have established a treatment plan, the focus shifts to protecting your progress, preventing falls, and monitoring your bone health. While the prospect of lifelong management can feel daunting, it is a highly effective way to maintain your independence and quality of life.

Fall Prevention: Your First Line of Defense

A diagnosis of osteoporosis doesn’t cause pain or fractures on its own; it is the impact from a fall that creates the risk. Therefore, fall prevention is just as important as medication:

  • Targeted Exercise: Programs that focus on balance, such as Tai Chi, and resistance training to strengthen muscles are proven to reduce the risk of falling [1][2]. Crucial Warning: You must avoid exercises involving spinal flexion (forward bending) or deep twisting—like sit-ups, toe touches, or aggressive yoga poses—as these put dangerous pressure on fragile vertebrae [2].
  • Environmental Safety: Most falls happen at home. Simple steps like removing loose rugs, improving lighting, installing grab bars in the bathroom, and being extremely careful around pets (a surprisingly frequent cause of tripping) can significantly lower your risk [3].
  • Multifactorial Assessment: Talk to your doctor about a full “fall risk assessment,” which includes checking your vision, reviewing medications that might cause dizziness, and evaluating your footwear [4][5].

Routine Monitoring and “Scanxiety”

To ensure your treatment is working, you will likely have repeat DXA scans. While some patients start with annual scans, once your bone density is stable, monitoring every 2 to 3 years is common [6][7].

It is normal to experience scanxiety—stress or worry before a scan and while waiting for results [8]. To manage this:

  • Focus on the Present: Try to avoid “future-oriented” worries about the results and focus on the daily habits you are already doing to support your bones [9].
  • Ask for Context: When looking at results, ask your doctor about the Least Significant Change (LSC). This is a technical term for the small, normal fluctuations in the machine’s readings that don’t actually represent a real change in your bone density [10].

Contextualizing Rare Side Effects

You may have heard about two rare side effects associated with long-term “bone-protector” (antiresorptive) medications:

  1. MRONJ (Medication-Related Osteonecrosis of the Jaw): A condition where the jawbone has difficulty healing, usually after an invasive dental procedure like an extraction [11][12].
  2. AFF (Atypical Femoral Fracture): A rare type of “stress fracture” in the thigh bone [13].

It is important to know that drug holidays (discussed on the previous page) are frequently used specifically to mitigate these long-term risks for patients whose bones have stabilized. The absolute risk of these events is extremely low—often estimated at 1 in 10,000 to 1 in 100,000 patients [11][14]. In contrast, the benefit of these medications is massive: for every one rare side effect that occurs, hundreds of life-threatening hip or spinal fractures are prevented [14]. You can further lower your risk of MRONJ by maintaining excellent oral hygiene and having a dental check-up before starting treatment [11][15].

The Path of a “Bone Survivor”

Osteoporosis is a chronic condition, much like high blood pressure or diabetes. By combining medical therapy with active fall prevention and regular monitoring, you are taking control of your future. The goal is not just to have a “better scan” but to live a full, active life without the fear of a fracture holding you back.

Common questions in this guide

How often do I need a DXA scan for osteoporosis?
Once your bone density is stable, monitoring with a DXA scan every 2 to 3 years is common. Your doctor will determine the exact schedule based on your individual treatment plan and progress.
What exercises should I avoid if I have osteoporosis?
You should avoid exercises that involve spinal flexion (forward bending) or deep twisting, such as sit-ups, toe touches, or aggressive yoga poses. These movements put dangerous pressure on fragile vertebrae.
Do I need to stop taking my osteoporosis medication before dental work?
You may need to pause certain long-term medications before invasive dental procedures, like extractions, to reduce the risk of jaw complications. Always inform your dentist about your osteoporosis medications and coordinate care with your doctor.
What is the risk of MRONJ or atypical femur fractures?
The absolute risk of these rare side effects is extremely low, estimated between 1 in 10,000 to 1 in 100,000 patients. The benefit of these medications in preventing life-threatening hip or spinal fractures far outweighs this small risk.
What is the Least Significant Change (LSC) on a DXA scan?
The Least Significant Change refers to the small, normal fluctuations in the DXA machine's readings that do not represent an actual change in your bone density. Knowing this number helps you and your doctor interpret whether a scan result is truly showing improvement or bone loss.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is the 'least significant change' for the DXA machine we use, and how does that help you interpret my results?
  2. 2.Given my specific fracture risk, how long do you anticipate I will stay on this medication before we re-evaluate?
  3. 3.Should I see a physical therapist to learn 'bone-safe' ways to practice resistance training or Tai Chi?
  4. 4.If I need an invasive dental procedure (like an extraction), do I need to pause my medication?
  5. 5.Can we set up a plan to discuss my scan results quickly to help manage my anxiety during the waiting period?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (15)
  1. 1

    Implementing Tai Chi Exercise in Long-Term Care to Reduce Falls.

    Miles AF, Mulkey DC

    Journal of nursing care quality 2024; (39(3)):220-225 doi:10.1097/NCQ.0000000000000756.

    PMID: 38030147
  2. 2

    Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour.

    Pinheiro MB, Oliveira J, Bauman A, et al.

    The international journal of behavioral nutrition and physical activity 2020; (17(1)):150 doi:10.1186/s12966-020-01040-4.

    PMID: 33239014
  3. 3

    Environmental interventions for preventing falls in older people living in the community.

    Clemson L, Stark S, Pighills AC, et al.

    The Cochrane database of systematic reviews 2023; (3()):CD013258 doi:10.1002/14651858.CD013258.pub2.

    PMID: 36893804
  4. 4

    Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review.

    Colón-Emeric CS, McDermott CL, Lee DS, Berry SD

    JAMA 2024; (331(16)):1397-1406 doi:10.1001/jama.2024.1416.

    PMID: 38536167
  5. 5

    Prevalence and predictors of low bone mineral density in Myasthenia gravis.

    Ducci RD, Santana LF, Kay CK, et al.

    Arquivos de neuro-psiquiatria 2026; (84(5)):1-8 doi:10.1055/s-0046-1824431.

    PMID: 42398964
  6. 6

    Intervals between bone mineral density testing with dual-energy X-ray absorptiometry scans in clinical practice.

    Lyu H, Yoshida K, Tedeschi SK, et al.

    Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2019; (30(4)):923-927 doi:10.1007/s00198-019-04847-5.

    PMID: 30680429
  7. 7

    Incidence and Predictors of Repeat Bone Mineral Densitometry: A Longitudinal Cohort Study.

    White VanGompel EC, Franks P, Robbins JA, Fenton JJ

    Journal of general internal medicine 2017; (32(10)):1090-1096 doi:10.1007/s11606-017-4094-y.

    PMID: 28634907
  8. 8

    Exploring psychological distress, appraisal, and coping during the scan result journey: a qualitative study of young and middle-aged Chinese adults with advanced cancer.

    Li X, Lu Y, Fan Y, et al.

    BMC cancer 2026; (26(1)).

    PMID: 41906115
  9. 9

    Coping With 'Scanxiety': Within-Person Processes in Lung Cancer.

    Dunsmore VJ, Neupert SD

    Psychological reports 2025; (128(2)):702-722 doi:10.1177/00332941231164336.

    PMID: 36964680
  10. 10

    CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE QUALITY OF DXA SCANS AND REPORTS.

    Licata AA, Binkley N, Petak SM, Camacho PM

    Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2018; (24(2)):220-229 doi:10.4158/CS-2017-0081.

    PMID: 29466058
  11. 11

    Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study.

    Hasegawa T, Hayashida S, Kondo E, et al.

    Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2019; (30(1)):231-239 doi:10.1007/s00198-018-4746-8.

    PMID: 30406309
  12. 12

    Medication-related osteonecrosis of the jaw following osteoporosis therapy: A real-world retrospective cohort study using the TriNetX global collaborative network.

    Chen TY, Deng YL, Chen IC, et al.

    Bone 2026; (202()):117678 doi:10.1016/j.bone.2025.117678.

    PMID: 41106713
  13. 13

    A Case Report of Oral Bisphosphonate Treatment for Osteoporosis Leading to Atypical Femoral Fracture and Pathologic Mandibular Fracture.

    Fernandes TL, Viezzer Fernandes B, Jitumori C, Franco GCN

    The American journal of case reports 2023; (24()):e941144 doi:10.12659/AJCR.941144.

    PMID: 37867315
  14. 14

    Change in Bone Mineral Density Is an Indicator of Treatment-Related Antifracture Effect in Routine Clinical Practice: A Registry-Based Cohort Study.

    Leslie WD, Majumdar SR, Morin SN, Lix LM

    Annals of internal medicine 2016; (165(7)):465-472 doi:10.7326/M15-2937.

    PMID: 27428723
  15. 15

    Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan.

    Wei LY, Cheng YW, Chiu WY, et al.

    Head & neck 2025; (47(4)):1151-1161 doi:10.1002/hed.28011.

    PMID: 39611589

This page provides educational information on managing osteoporosis and preventing falls. It does not replace professional medical advice from your doctor or physical therapist regarding your specific fall risk or medication management.

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