We sit down with Dr. Paul Anderson, a nationally recognized orthopaedic spine surgeon and longtime leader in bone health, to explain how bone fragility quietly drives pseudoarthrosis, hardware failure, periprosthetic fracture, and revision surgery across orthopaedics, including spine fusion, total hip and knee arthroplasty, shoulder procedures, and sports medicine repairs. Our goal is simple: help you make bone health optimization a normal part of elective surgical planning, not an extra task that never fits the schedule. 

We start by clearing up a common trap: relying on a DEXA T-score alone. Dr. Anderson walks us through a more operational definition of clinical osteoporosis that combines bone mineral density, fragility fracture history, and the FRAX 10-year fracture risk calculator. That broader view catches the patients who “do not look osteoporotic” on paper but still have fragile bone and higher risk of poor outcomes after surgery. 

From there, we lay out a step-by-step workflow you can actually run in clinic: who to screen, when to order DEXA, how to use imaging clues like CT Hounsfield units, and why orthopaedic surgeons should feel confident interpreting DEXA quality and results. We also cover how to build referral pathways using fracture liaison services, how to think about antiresorptive vs anabolic medications, and what timing looks like when you decide to delay surgery to improve bone strength. 

If you want fewer failures, fewer fractures, and more predictable fixation, bone health has to be part of the plan. Subscribe and share this with a colleague.