Frequent Fractures: How to Get to the Bottom of It

If you find yourself asking, “why do I keep breaking bones?”, you’re not alone—and it’s definitely worth looking into. While an occasional fracture can happen to anyone, recurrent breaks often point to an underlying issue that needs attention. This guide will help you understand possible causes, what tests you might need, and how to advocate for your bone health.

Recognizing a Pattern

Before diving into tests and treatments, consider:

• How many fractures have you had—and over what time span?
• Were the breaks from major trauma (a car crash) or minor incidents (twisting an ankle)?
• Which bones are affected most often?
• Do you feel bone pain or tenderness between breaks?

Answering these questions can help your doctor decide which evaluations to order.

Common Reasons You Keep Breaking Bones

1. Osteoporosis
   • Most common in older adults, especially postmenopausal women
   • Bones lose density, making them fragile
   • Often silent until a fracture occurs

2. Osteopenia
   • Mild bone loss, a precursor to osteoporosis
   • Shows up on a bone density scan (DEXA)
   • An early warning sign you can address

3. Nutritional Deficiencies
   • Low calcium and vitamin D weaken bone structure
   • Severe malnutrition or eating disorders can play a role
   • Certain diets (very low-calcium) increase risk

4. Hormonal Imbalances
   • Low estrogen or testosterone reduces bone formation
   • Overactive thyroid (hyperthyroidism) speeds up bone breakdown
   • High cortisol (Cushing’s syndrome) also harms bone

5. Genetic Bone Disorders
   • Osteogenesis imperfecta (brittle bone disease) leads to fragile bones from birth
   • Rare syndromes can affect collagen or mineralization

6. Medications and Treatments
   • Long-term use of steroids (prednisone) thins bones
   • Some cancer treatments, anticonvulsants, and proton-pump inhibitors have bone-weakening side effects

7. Chronic Illnesses
   • Rheumatoid arthritis, lupus, inflammatory bowel disease impair bone health
   • Kidney or liver disease can disrupt vitamin D activation

8. Lifestyle Factors
   • Smoking and heavy alcohol use reduce bone density
   • Lack of weight-bearing exercise means bones aren’t stressed enough to stay strong

How Doctors Figure It Out

To understand why you keep breaking bones, your healthcare team will likely combine:

1. Detailed Medical History

• Personal history of fractures and injuries
• Family history of osteoporosis or genetic bone disorders
• Medication and supplement use
• Diet, exercise, smoking, and alcohol habits

2. Physical Exam

• Posture and height (height loss can signal vertebral fractures)
• Bone tenderness or deformities
• Signs of hormonal imbalance (e.g., skin changes, muscle weakness)

3. Laboratory Tests

• Calcium, phosphate, magnesium levels
• Vitamin D (25-hydroxyvitamin D)
• Thyroid function (TSH, T4)
• Parathyroid hormone (PTH)
• Markers of bone turnover (in some cases)

4. Bone Density Scan (DEXA)

• Measures bone mineral density (BMD) at spine and hip
• T-score: above –1 is normal; –1 to –2.5 suggests osteopenia; below –2.5 indicates osteoporosis

5. Imaging Studies

• X-rays of injured sites to evaluate fracture pattern
• Vertebral fracture assessment
• MRI or CT if more detail is needed

6. Genetic Testing (When Indicated)

• If osteogenesis imperfecta or another rare disorder is suspected
• Usually done by a specialist in metabolic bone disease

Managing and Preventing Future Fractures

Once you have a diagnosis, you and your doctor can build a plan:

• Nutrition and Supplements
– Aim for 1,000–1,200 mg of calcium daily (diet first, supplements if needed)
– Maintain vitamin D levels in the optimal range (30–50 ng/mL)

• Medications
– Bisphosphonates (e.g., alendronate) slow bone loss
– Denosumab, teriparatide, or raloxifene may be options depending on your situation
– Hormone replacement therapy (HRT) for certain postmenopausal women

• Exercise
– Weight-bearing activities (walking, dancing, stair climbing) strengthen bones
– Resistance training (lifting weights, resistance bands) builds muscle and supports bone
– Balance exercises (tai chi, yoga) lower fall risk

• Lifestyle Changes
– Quit smoking—nicotine harms bone cells
– Limit alcohol to 1 drink per day for women, 2 for men
– Prevent falls at home: remove loose rugs, add grab bars in bathrooms, ensure good lighting

• Monitoring
– Repeat DEXA scans every 1–2 years if you have osteoporosis or high fracture risk
– Regular lab checks for vitamin D and relevant hormones

When to Act Quickly

While many causes of frequent fractures are chronic and manageable, certain red flags warrant urgent attention:

• Sudden, severe bone pain without trauma
• Rapid height loss or marked spinal curvature
• Signs of infection: fever, redness, or swelling around a fracture
• New neurological symptoms (numbness, weakness) after a break

If any of these occur, please speak to a doctor right away.

Take the Next Step

Unsure where to begin? Consider doing a free, online symptom check, using the doctor approved Ubie Symptom Checker to get personalized guidance on which specialists to see and which tests you might need.

Finally, nothing replaces a conversation with a healthcare professional. If you’re frequently breaking bones, speak to a doctor about your concerns—especially if you notice serious symptoms or anything life threatening. Identifying the root cause is the first step toward stronger, healthier bones.