Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Osteoporosis: Not Just a Hip Problem

Osteoporosis — the systemic reduction in bone density and strength — is most publicly associated with hip and spine fractures, but its effects on the foot and ankle are clinically significant and frequently underrecognized. Stress fractures in osteoporotic bone occur with minimal trauma; fractures that would not occur in a young healthy skeleton result from ordinary walking or standing in patients with significant bone density loss. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we assess bone density risk as part of evaluating patients with fragility fractures and recurrent stress fractures.

How Osteoporosis Affects Foot and Ankle Fractures

The metatarsals — particularly the second and third metatarsals — are among the most common sites for osteoporotic stress fractures in the foot. Patients with osteoporosis may sustain metatarsal stress fractures from activities as mundane as prolonged walking or household activity — the mileage and intensity thresholds that apply to stress fractures in young athletes don’t apply to fragile osteoporotic bone. Calcaneal insufficiency fractures — stress fractures of the heel bone — occur in severely osteoporotic patients from ordinary weight-bearing and can be bilateral. The ankle — particularly the distal fibula — is another common fragility fracture site in osteoporotic patients.

Recognizing Osteoporotic Fragility Fracture Risk

Clinical red flags suggesting that a patient’s foot stress fracture warrants bone density evaluation: age over 50 in women or 65 in men; history of corticosteroid use (prednisone, dexamethasone — the most common medication cause of secondary osteoporosis); inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis); chronic gastrointestinal malabsorption conditions; minimal trauma mechanism for the fracture; bilateral or multiple simultaneous stress fractures; previous fragility fractures at other sites. Dual-energy X-ray absorptiometry (DEXA scan) is the standard bone density measurement — podiatrists may initiate the referral for DEXA and coordinate with primary care or endocrinology for treatment.

Treatment Implications

Osteoporotic foot fractures heal at the same biological rate as fractures in non-osteoporotic bone — but prevention of the next fracture requires treating the underlying bone density deficit. Calcium and vitamin D supplementation, bisphosphonate therapy, and lifestyle modification (weight-bearing exercise, fall prevention) reduce subsequent fracture risk. From the podiatric perspective: appropriate footwear with shock absorption, custom orthotics to reduce metatarsal peak pressure, and activity modification during fracture healing are combined with systemic osteoporosis management. Contact Balance Foot & Ankle at (810) 206-1402 for evaluation of foot and ankle fractures and assessment of underlying bone density risk.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Osteoporosis-Related Foot Problems

Osteoporosis increases the risk of stress fractures and insufficiency fractures in the foot, sometimes from everyday walking. At Balance Foot & Ankle, Dr. Tom Biernacki evaluates unexplained foot pain in osteoporosis patients, diagnoses occult fractures with advanced imaging, and provides treatment to protect fragile bones.

Learn About Our Fracture Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-1441.
2. Boden SD, Osbahr DC. High-risk stress fractures: evaluation and treatment. J Am Acad Orthop Surg. 2000;8(6):344-353.
3. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis — 2020 update. Endocr Pract. 2020;26(Suppl 1):1-46.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.