How to Be a Caregiver for Someone With Osteoporosis

You can help prevent falls and avoid life-changing fractures

Kim Painter,

AARP

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Published May 14, 2025

Caitlin Vlaeminck and her mother pose with a photo of Wendelborn’s mother

Caitlin Vlaeminck (back) and her mother, Colleen Wendelborn, 72, pose for a portrait with a photo of Wendelborn’s mother, Lorna Weber, at her home in South Bend, Indiana. Wendelborn was a caregiver for Weber until her death in 2023 at age 95.

Taylor Glascock

When Colleen Wendelborn welcomed her 90-year-old mother, Lorna Weber, into her South Bend, Indiana, home in 2018, she knew the “tiny, tiny” lady had bones so weak that she once broke a rib or two when “a husky (relative) gave her a great big hug,” Wendelborn recalls.

So, she did all she could to protect her mother, who had osteoporosis, from falls and fractures. She removed loose floor rugs, insisted Weber hold handrails on the stairs, and doled out daily calcium pills. Later, when Weber became weak from a heart condition, Wendelborn physically assisted her up and down stairs, getting in and out of cars and even walking down the sidewalk.

“The one time she slipped on the sidewalk, it was the one time I wasn’t holding on to her,” Wendelborn says. While Weber fractured an eye socket and wrist in that fall, she never broke a hip, avoiding the most serious potential consequence of osteoporosis. She died at 95 in 2023.

Experts say an involved caregiver like Wendelborn can make a big difference when a loved one has osteoporosis by helping them manage the condition and avoid life-altering fractures. If you care for someone with osteoporosis, here’s what you need to know.

(From left) Colleen Wendelborn, with her late mother, Lorna Weber, and daughter Caitlin Vlaeminck in 2020.

Courtesy Wendelborn

What is osteoporosis?

Bones are living, changing tissues. Our bodies constantly build them up and break them down. When we’re young, we build more bone than we lose. As we age, the balance changes, and our bones lose mass and strength. Certain medicines and illnesses, poor diet, inactivity, and other factors can speed up those losses. In women, menopause is a major tipping point.

When the balance tips too far, that’s osteoporosis — a word that means “porous bones.”

“It results because people either lose too much bone, make too little bone, or a combination of both,” says Andrea Singer, M.D., an internist at MedStar Georgetown University Hospital in Washington, D.C., and chief medical officer of the Bone Health & Osteoporosis Foundation.

The consequences: Bones can start breaking from falls that wouldn’t break stronger bones. Even bending, lifting, or coughing might break especially fragile bones. Wrists, spinal bones, and hips are most likely to break, and the fallout can be serious.

Spinal fractures can rob people of height and the ability to stand straight. A broken hip can sharply increase the risk of death and disability. “The number of people who are able to get back to normal life after a hip fracture is very limited,” says Ivy Alexander, a nurse practitioner and clinical professor at the University of Connecticut School of Nursing.

Fall Prevention and Protection

Helping someone with osteoporosis avoid falls is job one. Here are a few ways to do that:

Clear out clutter. Get rid of scatter rugs, extension cords, and other tripping hazards.
Remove leaves, ice, and snow. Make sure someone is in charge of keeping walkways and driveways clear of debris, says nurse practitioner Ivy Alexander.
Install safety aids. The National Institute on Aging suggests handrails on both sides of stairways, as well as grab bars near toilets, tubs, and showers.
Light the way. Make sure there’s good lighting in every room and a well-lit path between the bedroom and bathroom at night, Alexander says.
Ensure proper use of walkers and canes. If your loved one needs an assistive device, encourage them to use it inside and outside the house. A physical therapist can help select the best option and offer tips on using it. It’s important, for example, that a walker is the right height so “that you are standing nice and tall,” says physical therapist Robyn Culbertson.

How osteoporosis is diagnosed

Sometimes, osteoporosis is diagnosed by a bone density test, a kind of X-ray recommended for all women over age 65 and for younger postmenopausal women with risk factors like thinness, smoking, heavy alcohol use, or having a parent who broke a hip. Because men can get osteoporosis, too, some medical groups recommend bone density screening for men over 70 as well.

The test, which measures calcium and other minerals in bones, produces something called a T-score. A normal T-score, around 0, means someone has the bones of a healthy young adult. A score between -1 and -2.5 means somewhat low bone density (also called osteopenia), and scores of 2.5 or lower mean likely osteoporosis.

But osteoporosis can also be diagnosed based on the following:

Fracture. If you’re over 50 and break a hip or spinal bone (vertebra), you can be diagnosed with osteoporosis regardless of your T-score. And almost any other fracture, including breaking a wrist, shoulder, or rib, should lead to testing, though it often does not, Singer says. She notes that people are sometimes confused about whether “fracture” and “break” mean the same thing. They do, she says, and are always potential warning signs.

Fracture risk. In addition to a T-score, doctors consider factors like your age, sex, height, weight, smoking, drinking, and medications to estimate your fracture risk in the next 10 years. If your risk of breaking a hip is more than 3 percent or your risk of any major fracture is more than 20 percent, you can be diagnosed with osteoporosis.

About 10 million Americans have osteoporosis and another 44 million have low bone density, leading to about 2 million fractures each year, according to the bone foundation.

How osteoporosis is treated

The mainstays of osteoporosis treatment are medications that help strengthen bones and reduce fracture risk. There are two major types:

Antiresorptives.These drugs slow bone breakdown, which can increase bone density. They include drugs called bisphosphonates, like alendronate (Fosamax), and ibandronate (Boniva), as well as denosumab (Prolia), hormone therapies, and other medications. These are mostly taken as daily, weekly, or monthly pills or as intravenous infusions given every three to 24 months.

Anabolics. These directly stimulate bone building. They include teriparatide (Forteo and Bonsity), and abaloparatide (Tymlos), which are daily injections done at home, and romosozumab-aqqg (Evenity), an injection given at a medical office once a month.

Your loved one might speak with their primary provider or an osteoporosis specialist, such as an endocrinologist, about the right drug for them, Alexander says. The selection, she says, should be “very individualized.” For example, she says, bisphosphonate pills aren’t recommended if someone has reflux or can’t sit or stand up for half an hour without food or water after taking the medication. But they might get the same drug by infusion.

While antiresorptive drugs have long been more widely used, anabolic drugs are increasingly recommended as first choices for people with a very high risk of fracture due to age, a recent fracture, very low bone density, or other issues, Singer says. Anabolic drugs lower fracture risk the fastest, she says.

Osteoporosis drugs are sometimes used for a limited period or switched from one type to another. So, the recommended treatment can change over time, Singer and Alexander say.

Caregivers might want to be part of any drug choice conversation, the experts say. For one thing, you might need to help with home injections or help your loved one keep track of pill schedules or infusion appointments.

Osteoporosis drug side effects

The most common side effects of most osteoporosis drugs are temporary muscle and bone aches, Singer says.

Much rarer side effects have been seen in some people who take bisphosphonates or denosumab. These include unusual fractures of the thigh bone (femur), often after taking the drugs for more than five years. Doctors today usually recommend stopping or pausing the drugs before that, Singer and Alexander say.

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Another very rare side effect is osteonecrosis of the jaw, which is when part of the jawbone is exposed through an opening in the gum and doesn’t heal properly. It most often happens after major dental work and in cancer patients treated with very high doses of the medications, Alexander says.

It’s a good idea for patients to see a dentist and catch up on any major dental work before they start such drugs. Once your loved one is taking the drug, she says, make sure their dentist knows.

Overall, “in people who are at high risk for fracture, the benefits almost always outweigh the risks,” of osteoporosis drug treatment, Singer says.

Once your loved one is taking an osteoporosis drug, their doctor should monitor their progress with a bone density test at least every two years, the bone foundation says.

Osteoporosis and diet

We all need adequate calcium and vitamin D for healthy bones. The recommended calcium intake for women over age 50 and everyone over age 70 is 1200 mg. a day — about the amount in four cups of milk. Under U.S. government guidelines, the recommended vitamin D intake is 600 IU for people 51-70 and 800 IU for those over 70. Some health groups focused on osteoporosis recommend up to 1,000 IU for older adults. That’s equivalent to the amount in a serving of salmon, plus three cups of fortified milk.Meeting those goals is especially important for people with osteoporosis. To get enough vitamin D, many people need a supplement, says Caitlin Vlaeminck, a nurse practitioner who works with osteoporosis patients and is a clinical associate professor in nursing at Indiana University South Bend. (She’s also Colleen Wendelborn’s daughter and was Lorna Weber’s granddaughter). But, she says, many people can meet calcium goals with food or by adding enough supplemental calcium to fill in any gap.

Getting enough calcium doesn’t have to mean gorging on dairy foods, she and other experts say.

Other good sources of calcium include leafy greens like kale, bok choy, and collard greens, as well as canned fish with bones, tofu, almonds, and fortified juices and plant milks, says Angel Planells, a Seattle-based registered dietitian nutritionist and spokesperson for the Academy of Nutrition & Dietetics.

Protein, found in foods such as meat, eggs, beans, and nuts, is important to bone health too, Singer says, partly because it helps build muscle. That helps prevent falls.

Planells says a bone-healthy diet also limits salt and provides enough fluid to prevent dehydration, which increases the risk of falling.

Exercising for bone health

When someone has osteoporosis, “we like to encourage as much weight-bearing exercise as possible because bone grows when it has sufficient proper stress on it,” says Robyn Culbertson, a physical therapist who works with older adults in their homes in Columbia, South Carolina. Walking, running, lifting weights, pulling resistance bands, and moves like squats and lunges provide that kind of stress; water aerobics and biking generally don’t, says Culbertson, a spokesperson for the American Physical Therapy Association.

A well-rounded strength and muscle-building routine will do your loved one the most good, Alexander says. Walking can strengthen legs and hips, she says, “but it’s not going to do anything for your upper back, your shoulders, your arms, your wrists.”

But people with osteoporosis need to use extra care, Culbertson says. For some, a crunch or sit-up might fracture fragile spinal bones. Jogging is too high-impact for many. “Don’t start anything if you have osteoporosis without talking to your doctor or a physical therapist,” she urges.

Culbertson often has patients stand on unstable surfaces like a foam pad with their eyes closed to challenge their balance system. “I like to involve the caregiver in helping the patient be safe with the activity — show them how I spot the patient” so they can practice the activity together even when she is not there.

Vlaeminck says that while she has some osteoporosis patients who play pickleball or keep skiing — with great caution and proper gear — the right exercise for others can be lifting soup cans during TV commercials and walking in place.

If your loved one likes group exercise, she says, many communities offer classes designed for people with osteoporosis. Some go by the name Bone Builders, she says, and are taught by professionals trained in a program called BoneFit.

Also recommended: activities that improve balance and potentially reduce falls. Yoga and tai chi can be good choices, Alexander says. Some classes, including online versions, offer sitting options. A bonus of online courses, she says, is that caregivers can easily join in.

Watching for changes

People often live with osteoporosis for decades. Over time, caregivers may notice changes that might mean a loved one needs medical attention or new kinds of support, the experts say.

“Sometimes family members can tell when something just doesn’t seem right,” Singer says.

Singer says her own mother had been living with osteoporosis for a long time, with no fractures, when at 77, she started complaining of lower back pain. “As people get older, I think sometimes we dismiss those kinds of things,” Singer says. But her mother’s back pain turned out to be from a vertebral fracture. Getting it diagnosed, with a bit of prodding from her daughter, changed her treatment plan, Singer says.

Wendelborn says that when her mother’s legs weakened, she convinced her to see a physical therapist, who prescribed simple exercises to improve her walking and reduce her risk of falling.

In some cases, people with osteoporosis face increasing fall risks because they develop other conditions. For example, someone with dementia might start wandering away from caregivers and safe spaces. Creative solutions, like padded hip shorts, might help keep them safer, Alexander says.

Singer says changes you might not notice in hearing and vision can also increase fall risk, so it’s important to keep eyeglass and hearing aid prescriptions up to date.

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Kim Painter is a contributing writer who specializes in health and psychology. She frequently writes for AARP's Staying Sharp and previously worked as a health reporter and columnist at USA Today.