Bone Health, Osteoporosis Screening & Fracture Prevention

March 15, 2026

Article contributed by Prarthana Jain, DO MPH

March provides an important opportunity to refocus our collective efforts on bone health and fracture prevention: an area where proactive screening and interdisciplinary collaboration can significantly reduce long-term morbidity.

Osteoporosis remains underdiagnosed and undertreated, particularly in high-risk populations. Too often, the first clinical presentation is a fragility fracture, an event associated with increased mortality, functional decline and loss of independence. As specialists and primary care providers, we are uniquely positioned to prevent that first fracture.

At NCRA, our March initiative centers on three priorities:

Early identification,
Appropriate intervention and
Coordinated care.

The Ongoing Gap in Screening

Despite clear guidelines, osteoporosis screening rates remain inconsistent. Patients with rheumatic disease are at particularly elevated risk due to chronic systemic inflammation, glucocorticoid exposure, reduced physical activity and early menopause or hypogonadism.

In clinical practice, we frequently see patients who meet criteria for DXA evaluation but have not yet been screened, particularly those on chronic steroids or with prior vertebral fractures that were incidentally identified.

Proactive identification remains one of the most impactful interventions we can offer.

Who Should We Be Prioritizing?

Screening should be strongly considered in women ≥65 years, men ≥70 years, any adult with a history of fragility fracture, patients receiving chronic glucocorticoid therapy (≥2.5 mg prednisone equivalent for ≥3 months) and patients with high-risk inflammatory disease.

In inflammatory disease populations, including RA, SLE, vasculitis and spondyloarthritis, fracture risk is often underestimated when relying solely on BMD.

Beyond BMD: Comprehensive Risk Assessment

While DXA remains central, fracture prevention requires a broader approach, including FRAX calculation (with glucocorticoid adjustment when appropriate), assessment of fall risk, medication review, evaluation for secondary causes and optimization of Vitamin D.

Treatment Considerations in Complex Patients

Therapeutic options continue to expand, allowing for individualized care. These include oral and IV bisphosphonates, denosumab, anabolic agents and sequential therapy strategies.

In patients transitioning off anabolic therapy, ensuring appropriate antiresorptive follow-up remains critical to preserve BMD gains.

For glucocorticoid-induced osteoporosis, early intervention, often at lower BMD thresholds, can substantially reduce vertebral fracture risk.

The Importance of Coordination

Fracture prevention works best within a collaborative framework.

Primary care teams often initiate screening and longitudinal monitoring. Rheumatologists frequently manage high-risk patients and those with chronic steroid exposure. Clear communication allows us to prevent gaps in screening, align on treatment thresholds, ensure follow-up DXA timing and reduce missed opportunities for therapy.

Shared care improves outcomes and decreases long-term healthcare burden.

Our Commitment This March

NCRA is committed to supporting guideline-based osteoporosis screening, identifying high-risk patients early, providing evidence-based fracture risk management, and coordinating closely with PCPs.

Bone health is preventive medicine in action. By working together, we can protect mobility, preserve independence and reduce fracture-related morbidity in our shared patient population.

Let’s make March a month of prevention, partnership and stronger outcomes.