“The Bones of the Matter”

Prairie Doc Perspective Week of February 15th, 2026
“The Bones of the Matter”
By Deb Johnston, MD


When I was in medical school, I learned that a shocking number of people would die or be admitted to a nursing home after a hip fracture. 


Even today, a hip fracture can be a devastating event for an older American. Up to 30% will die within the next year. Many more will loose independence and require admission to assisted living or a nursing home. Estimates vary, but it may approach 50%. As hard as it is to believe, these statistics are improved from my long ago medical school days.


As a doctor in training, the solution seemed obvious. If osteoporosis caused hip fractures, and hip fractures caused premature death and disability, then my mission as a primary care physician would be to prevent osteoporosis. I’ve been nagging my patients about their calcium and vitamin D intake and their weight bearing exercise ever since.


To be fair, the reality is a bit more nuanced. It’s true that osteoporosis is a major factor in hip fractures, but it is often accompanied by other issues: poor nutrition, poor balance, low muscle mass, and more obvious serious health conditions like dementia, heart disease, kidney disease, and diabetes. 


Similarly, preventing osteoporosis isn’t as simple as urging everyone to drink enough milk. Generally we can build stronger bones up until about age 30. After that, the goal is to maintain bone mass. Those critical years are often decades before a person starts thinking about their bones, and sometimes well before they start thinking about their health at all! 


Other habits also influence how strong your bones are at their best. Smoking and alcohol reduce bone mass. Weight bearing exercise increases it; while being sedentary has the opposite effect. Your body needs vitamin D to make bone, too, and deficiencies are surprisingly common. 


Other health conditions, and their treatments, can have significant influences on your bone health. The list is long: eating disorders, premature menopause, inflammatory bowel disease, seizure disorders, asthma, rheumatoid arthritis, chronic kidney disease, thyroid disease, cancer.


While preventing osteoporosis starts in childhood, hope is not lost just because you are well into middle age, or older. Talk with your doctor about what you should be doing to keep your bones healthy. Do you need help getting rid of nicotine, or cutting back on alcohol? Are you having trouble getting enough calcium or vitamin D? Are there medications you are taking that could be changed? Is it time to start screening?


While many people think about osteoporosis as a woman’s disease, it affects men too, albeit at lower rates. In fact, men may have a higher risk of death after a hip fracture. We all need to be thinking about our bones. It’s never too early. Or too late.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).