Lifestyle Medicine and Osteoporosis in Viet Nam: Strength and Balance Training, Fracture Risk, and Medication Safety

Lifestyle Medicine and Osteoporosis in Viet Nam: Strength and Balance Training, Fracture Risk, and Medication Safety

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

An older adult falls at home and fractures their wrist. After receiving treatment, the immediate concern is whether the bone will heal and when normal activities can resume. Once the pain improves, they may be advised to walk more, eat calcium-rich foods, and take better care of their bones.

These suggestions are reasonable, but an important question may remain unanswered: was the fracture a warning sign of osteoporosis, and what should be done to prevent another one?

A fracture following a fall from standing height can indicate underlying skeletal fragility. It may also identify someone at increased risk of another fracture, particularly during the first one to two years after the initial event. If care focuses only on healing the injured bone, an important opportunity for prevention may be missed.

Evidence-based Lifestyle Medicine can contribute to bone and muscle health through appropriate physical activity, adequate nutrition, and other healthy behaviors. However, improving bone strength, reducing falls, and preventing fractures are related but different objectives. The interventions needed to achieve them are not necessarily the same.

For healthcare professionals in Viet Nam, the challenge is to connect lifestyle-related interventions with appropriate fracture risk assessment, medical treatment, rehabilitation, and follow-up. Exercise and nutrition have important roles, but they cannot always replace medication in someone at high risk of fracture.

Osteoporosis Is More Than a Bone Density Result

Osteoporosis is a skeletal disorder characterized by reduced bone strength and increased susceptibility to fracture. It often develops without obvious symptoms until a fracture occurs.

Bone mineral density is an important part of assessment, but it does not capture every factor influencing fracture risk.

Dual-energy X-ray absorptiometry, commonly known as DXA, is the established reference method for measuring bone mineral density. In postmenopausal women and men aged 50 years or older, a T-score of −2.5 or lower at an appropriate skeletal site is consistent with densitometric osteoporosis. [1]

However, fracture risk does not change suddenly at a single numerical threshold.

An older person with a T-score above −2.5 may still have substantial fracture risk because of previous fractures, advanced age, frequent falls, glucocorticoid exposure, or other clinical factors. Conversely, people with similar bone density measurements may have different risks because of differences in medical history, physical function, and exposure to falls.

A previous low-trauma hip or vertebral fracture is particularly important. In appropriate clinical circumstances, such a fracture may establish osteoporosis or justify pharmacological treatment even when bone density measurements do not meet the conventional threshold.

This principle should not be generalized to every fracture. The mechanism of injury, fracture location, and possible alternative causes, including malignancy or other skeletal disorders, require clinical consideration.

Interpretation also differs in younger people. The International Society for Clinical Densitometry recommends using Z-scores rather than T-scores in premenopausal women and men younger than 50 years. In these groups, bone density findings should be interpreted within the wider clinical context rather than applying diagnostic criteria intended for older adults without adjustment. [1]

Fracture risk assessment therefore involves more than reviewing a DXA report.

Previous low-trauma fractures, age, family history, body weight, medication exposure, relevant medical conditions, and factors contributing to falls may all influence risk.

Internationally, tools such as the Fracture Risk Assessment Tool, commonly known as FRAX, are used to estimate the ten-year probability of major osteoporotic and hip fractures. These tools can support clinical decision-making, but their performance and interpretation depend on the population model used and its calibration.

A calculated probability should not replace clinical judgment, and treatment thresholds developed in another country should not automatically be applied to Viet Nam.

For example, Singapore's Agency for Care Effectiveness published updated osteoporosis guidance in August 2025, including locally developed intervention thresholds for selected people with low bone mass. These thresholds incorporate Singapore-specific epidemiological, economic, and healthcare considerations. [2]

They provide a useful example of risk-based clinical decision-making but should not be treated as validated Vietnamese treatment thresholds.

Assessment also needs to consider possible secondary causes of skeletal fragility, including long-term systemic glucocorticoid use, certain endocrine disorders, malabsorption, chronic kidney disease, and some cancer treatments.

A history of height loss, new back pain, or changes in spinal posture may warrant evaluation for vertebral fracture, particularly in someone with established osteoporosis or other relevant risk factors.

The objective is not simply to identify people with low bone density. It is to recognize those who may benefit from further assessment, appropriate treatment, or preventive intervention before a serious fracture occurs.

The 2026 Exercise Guideline: Strength and Balance Have Different Purposes

Exercise is an important component of osteoporosis prevention and management, but different activities have different effects.

Some forms of physical activity primarily improve cardiovascular fitness. Others provide mechanical loading that can benefit bone, increase muscle strength, or challenge the ability to maintain balance.

These outcomes are connected, but they should not be treated as interchangeable.

A person may be able to walk for an hour yet struggle to rise from a chair without using their hands. Another may have reasonable muscle strength but poor balance when turning, stepping over obstacles, or walking on uneven ground.

Improving bone mineral density does not eliminate every cause of falling. Similarly, better balance does not necessarily reverse low bone mineral density.

An important development occurred on February 16, 2026, when Kemmler and colleagues published an evidence- and consensus-based exercise guideline developed through the Osteology Umbrella Association in BMC Endocrine Disorders. [3]

The guideline addresses exercise for fracture prevention among defined groups of community-dwelling adults, primarily postmenopausal women and men aged 45 years or older with varying bone mineral density and fall risk.

It distinguishes several objectives, including improving bone strength, reducing fall risk, and reducing the physical consequences of falls.

The recommendations emphasize appropriate exercise selection, progressive training, individualization, and attention to safety. They also recognize the importance of qualified supervision when exercise involves greater physical demands or higher risk.

Importantly, the guideline does not establish a single exercise program that is optimal and safe for everyone.

Its recommendations should not be treated as universal exercise prescriptions. The guideline does not directly cover every population or clinical situation, including institutionalized older adults, premenopausal women, and all aspects of rehabilitation immediately after an acute fracture.

For Lifestyle Medicine, the practical lesson is that advising someone to exercise more is not enough. Healthcare professionals need to understand what the exercise is intended to achieve and whether it is appropriate for the individual.

Progressive Resistance Training Can Support Bone and Muscle Health

Bones respond to mechanical loading, and appropriately designed resistance training can help maintain or improve bone mineral density while increasing muscle strength.

For suitable individuals, progressive resistance training may include exercises challenging the major muscle groups of the legs, hips, trunk, and upper body.

The objective is to provide sufficient mechanical stimulus while maintaining safe movement patterns and allowing the body to adapt.

The 2026 exercise guideline recognizes the value of dynamic resistance training and appropriately selected weight-bearing or impact activities for improving bone strength. It also emphasizes progressive loading and suitable variation in training intensity. [3]

However, the appropriate type and intensity of exercise depend on the person's condition.

A relatively healthy adult with low bone mass and no previous fracture may tolerate activities that would be unsuitable for someone with severe osteoporosis, multiple vertebral fractures, or substantial physical limitations.

Progression matters. Introducing high resistance, high-impact movements, or technically demanding exercises too quickly may increase the risk of injury.

Someone who has been inactive for a long period may begin with manageable resistance and simple functional movements before progressing according to strength, balance, technique, and tolerance.

Walking, cycling, and swimming remain valuable activities for general health. They can support cardiovascular fitness, mobility, and daily functioning.

However, they do not provide identical mechanical stimuli to the skeleton.

Cycling and swimming generally provide less weight-bearing loading than appropriately selected land-based activities. Ordinary walking may also be insufficient to produce substantial improvements in bone mineral density in many otherwise mobile adults.

This does not mean these activities should be discouraged. It means that a program specifically intended to improve bone strength may need additional exercises.

A comprehensive approach may therefore combine activities supporting cardiovascular health with resistance and functional training intended to improve muscle and skeletal strength.

The appropriate combination should reflect individual goals, physical capacity, fracture history, and clinical risk.

Balance Training Addresses a Different Part of Fracture Risk

Many fragility fractures occur during falls.

Their causes may include impaired balance, muscle weakness, reduced vision, medication effects, environmental hazards, or several contributing factors acting together.

A program focused only on bone mineral density may leave these risks unaddressed.

Balance training aims to improve the ability to maintain stability during everyday activities and respond appropriately to changes in position or unexpected disturbances.

Exercises may include controlled weight shifting, stepping in different directions, turning, standing with a reduced base of support, or other appropriately supervised balance challenges.

The 2026 exercise guideline recommends challenging balance training as an important component of fall-prevention programs. It also recognizes the potential value of functional strength training, stepping exercises, Tai Chi, and other approaches when matched to individual capabilities. [3]

The challenge needs to be sufficient to produce improvement without exposing the person to an unreasonable risk of falling during training.

Someone with recurrent falls may require close supervision, a stable support surface, or additional safety measures. Another person with good mobility may benefit from progressively more demanding exercises.

Balance training should also be connected to everyday function.

Being able to rise from a chair, turn safely, negotiate uneven surfaces, or recover balance after a minor disturbance may be more relevant to independent living than performance on an isolated exercise test.

The 2026 guideline also considers strategies intended to reduce the impact of a fall, but these require particular caution. More complex techniques should not be introduced to people at increased fracture risk without appropriate professional competence and supervision.

The frequency, intensity, and progression of training should reflect the person's capabilities and clinical circumstances rather than a rigid schedule applied to everyone.

The aim is to improve functional stability while ensuring that exercise itself does not become a source of preventable injury.

Exercise Safety After a Vertebral or Hip Fracture

A previous osteoporosis-related fracture can change which movements are appropriate.

Someone recovering from a hip fracture may experience pain, muscle weakness, reduced walking confidence, and limitations related to surgery or bone healing.

A person with vertebral fractures may be concerned about bending, lifting, or returning to ordinary household activities.

These concerns should not automatically lead to prolonged inactivity.

Inactivity can contribute to muscle weakness, poorer balance, and reduced independence. However, returning to exercise without appropriate assessment may also create risks.

For people with significant osteoporosis or vertebral fractures, activities involving high or poorly controlled spinal loading may require modification.

Repeated loaded spinal flexion, forceful twisting, or movements placing substantial stress on vulnerable vertebrae may be inappropriate for certain patients.

This does not mean that everyone with osteoporosis must avoid all bending, lifting, or spinal movement. Safe movement strategies should reflect the individual's condition and functional needs.

Rehabilitation may initially emphasize safe transfers, postural control, functional strengthening, and supported balance activities before progressing to more demanding exercises.

People with recent fractures, severe or unexplained pain, neurological symptoms, or substantial mobility limitations may require specialist assessment before undertaking a structured exercise program.

The 2026 exercise guideline provides useful principles for people at increased fracture risk, but rehabilitation immediately after a fracture also requires consideration of healing, treatment, surgical restrictions when relevant, and the person's wider medical condition.

Exercise can support recovery, but the program must be appropriate for the stage of healing and the risk of further injury.

Nutrition Supports Bone Health but Cannot Replace Treatment

Adequate nutrition contributes to bone and muscle health throughout life.

Calcium is required for bone mineralization, vitamin D supports calcium absorption and mineral metabolism, and protein is important for maintaining muscle mass and supporting physical recovery.

However, osteoporosis management should not be reduced to taking calcium supplements or increasing consumption of one particular food.

The UK National Osteoporosis Guideline Group recommends a balanced, nutrient-rich diet and adequate calcium intake, preferably through food, with supplementation when dietary intake is insufficient. It also emphasizes adequate vitamin D intake and appropriate supplementation for people with relevant deficiencies or risk factors. [4]

These recommendations do not mean that every adult should automatically take high-dose calcium or vitamin D supplements.

Individual requirements depend on age, dietary intake, nutritional status, medical conditions, and the treatment being used.

Excessive supplementation may create additional risks, including hypercalcemia and kidney-related complications in susceptible individuals.

People with chronic kidney disease, disorders of calcium metabolism, a history of kidney stones, or other relevant conditions may require more specific assessment.

For older adults, inadequate total energy and protein intake also deserve attention.

A person who is underweight, losing weight unintentionally, or recovering from a fracture may have different nutritional priorities from someone who is overweight but otherwise adequately nourished.

Unnecessarily restrictive diets can worsen muscle loss, frailty, and physical function.

In Viet Nam, dietary counseling should consider familiar and affordable sources of calcium and protein. These may include suitable dairy or fortified products, calcium-containing tofu, fish eaten with edible bones when appropriate, and other locally available foods.

The calcium content and bioavailability of particular foods vary according to their composition and preparation. Not every type of tofu, vegetable, or fortified product provides the same nutritional value.

Healthcare professionals should therefore consider overall dietary intake rather than assume that a short list of foods will adequately protect bone health.

Dietary improvement can support treatment and recovery, but it has not been established as a substitute for effective osteoporosis medication in people who have a clear indication for pharmacological fracture prevention.

Medication Is Important for Some Patients at High Fracture Risk

A person diagnosed with osteoporosis may prefer to begin with exercise, diet, and supplements rather than medication.

These preferences deserve discussion, but their clinical implications depend on fracture risk.

Someone with mildly reduced bone mass and no previous fragility fracture may have different treatment needs from a person who has already sustained a hip or vertebral fracture.

For patients at high or very high fracture risk, appropriate pharmacological treatment can substantially reduce the risk of future fractures.

The 2025 Singapore osteoporosis guideline recommends pharmacological treatment for selected adults with established osteoporosis or previous fragility fractures, together with risk-based treatment consideration for some people with low bone mass. [2]

The UK National Osteoporosis Guideline Group similarly recommends treatment for people at high or very high fracture risk and emphasizes prompt intervention following fragility fractures. [4]

Medication selection depends on individual circumstances.

Antiresorptive medicines, including bisphosphonates and denosumab, reduce bone resorption. Bone-forming therapies may be considered for selected patients at very high fracture risk, often with specialist involvement.

These treatments have different indications, administration requirements, safety considerations, and follow-up needs.

The choice should consider fracture history, kidney function, calcium status, associated conditions, treatment preferences, affordability, and access.

For some patients at very high fracture risk, treatment sequence also matters. A course of bone-forming therapy generally needs to be followed by appropriate antiresorptive treatment to maintain the benefits achieved.

The objective is to reduce clinically important fractures, not simply improve a bone density measurement.

Lifestyle interventions can remain part of the treatment plan while medication addresses skeletal fragility that exercise or nutrition alone may not adequately control.

Medication Safety Requires a Long-Term Plan

Osteoporosis treatment may continue for several years, so medication safety and continuity are important.

Bisphosphonates are commonly used because they have demonstrated fracture-risk reduction in appropriate patient populations. However, their suitability depends on clinical characteristics, including kidney function and the ability to use the prescribed formulation correctly.

Some oral bisphosphonates have specific administration requirements intended to support absorption and reduce esophageal irritation. Patients need clear instructions and appropriate follow-up rather than assuming that all osteoporosis medicines can be taken in the same way.

Long-term antiresorptive treatment has also been associated with uncommon but important adverse effects, including atypical femoral fractures and osteonecrosis of the jaw.

These events are rare at doses commonly used for osteoporosis treatment, and their risks need to be considered alongside the burden of untreated osteoporosis in patients who require medication.

New persistent thigh or groin pain during long-term antiresorptive treatment may warrant assessment for an atypical femoral fracture.

Good oral health, appropriate dental care, and communication between medical and dental professionals are also relevant. Concerns about rare jaw complications should not automatically lead to withholding necessary osteoporosis treatment or avoiding all dental procedures.

Medication review should focus on the person's overall balance of benefits and risks.

Treatment duration is another important consideration.

After an appropriate period of bisphosphonate therapy, clinicians may consider a supervised treatment interruption in selected patients whose fracture risk has become sufficiently low. This is sometimes called a bisphosphonate drug holiday.

It is not a universal recommendation and should not be applied to all osteoporosis medications.

Denosumab, in particular, requires a different approach to treatment discontinuation.

Denosumab Should Not Be Stopped Without a Treatment Plan

Denosumab is an effective antiresorptive treatment for appropriately selected patients with osteoporosis.

Unlike bisphosphonates, which can remain in bone for an extended period, the effects of denosumab decline relatively rapidly after treatment is discontinued.

Stopping or substantially delaying denosumab without appropriate follow-on treatment can lead to increased bone turnover, rapid loss of bone mineral density, and an increased risk of vertebral fractures, sometimes involving multiple vertebrae.

This is an important medication-safety concern because patients may assume that treatment can be stopped once their bone density improves or they no longer experience symptoms.

The UK National Osteoporosis Guideline Group strongly recommends establishing a long-term management plan before denosumab treatment begins. Patients and responsible healthcare professionals should understand that treatment must not be stopped or delayed without appropriate medical review. [4]

If discontinuation is clinically necessary, suitable follow-on therapy and monitoring need to be planned.

The guideline includes recommendations for sequential antiresorptive treatment, but these are clinical decisions requiring individualized assessment rather than instructions for patients to manage independently.

The issue is particularly relevant when appointments are missed, medication becomes unavailable, or the patient is uncertain about why treatment must continue.

Denosumab also requires attention to calcium balance and kidney-related risks.

In January 2024, the United States Food and Drug Administration added a boxed warning concerning severe hypocalcemia in patients with advanced chronic kidney disease receiving denosumab for osteoporosis, particularly those receiving dialysis or living with chronic kidney disease–mineral and bone disorder. [5]

This warning emphasizes the importance of appropriate patient selection, assessment, and monitoring. It is a United States regulatory communication and should not be misrepresented as a separate Vietnamese prescribing requirement.

The broader lesson is that medication safety involves both the risks of treatment and the consequences of inappropriate interruption.

Improvement in nutrition, physical activity, or bone density does not automatically justify stopping an effective osteoporosis medication.

Preventing Another Fracture Requires More Than Treating the First

A person who has already sustained a fragility fracture represents an important opportunity for secondary prevention.

However, responsibility for care may become fragmented.

An orthopedic team may focus on surgery or fracture healing, while osteoporosis assessment, fall prevention, and long-term medication management are left to another service.

If responsibilities are not clearly coordinated, the patient may recover from one fracture without receiving appropriate prevention for the next.

Fracture Liaison Services have been developed internationally to address this problem.

These services generally use a coordinated approach to identify people with fragility fractures, assess osteoporosis and falls risk, arrange appropriate treatment, and support follow-up.

The UK National Osteoporosis Guideline Group recommends access to multidisciplinary, coordinator-based fracture liaison services for people who sustain fragility fractures. [4]

A joint position paper published in European Geriatric Medicine on September 10, 2026, by seven international organizations further emphasized the importance of connecting fracture prevention with fall prevention. The paper highlighted that these services are often organized separately, creating gaps in care for people who need both approaches. [6]

For Lifestyle Medicine, this distinction matters because different interventions address different aspects of risk.

Medication may improve skeletal protection, while appropriately selected strength and balance training may reduce important contributors to falling. Home safety, vision assessment, medication review, and rehabilitation may also be necessary.

No single intervention necessarily compensates for the absence of the others.

Implementation can be adapted to local resources. Not every healthcare facility needs to establish a fully developed fracture liaison service immediately, but patients should have a reliable pathway from fracture treatment to appropriate secondary prevention.

The important question is whether the person receives appropriate assessment, treatment, and follow-up, not merely whether a referral has been issued.

Osteoporosis Care in Viet Nam: Existing Foundations and Remaining Gaps

Viet Nam has an established Ministry of Health clinical reference for osteoporosis within the Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases, approved under Decision No. 361/QĐ-BYT on January 25, 2014. [7]

The guidance includes osteoporosis diagnosis and treatment. The material was subsequently published in book form in 2016, a date that should be distinguished from the original Ministry of Health decision.

Because international evidence and treatment options have continued to develop, this national reference should be considered alongside newer research, relevant professional guidance, and current regulatory requirements.

An important regional perspective is provided by the APCO–IOF Asia Pacific Regional Audit, published in 2025 by the Asia Pacific Consortium on Osteoporosis and the International Osteoporosis Foundation. [8]

The audit examined osteoporosis and fragility fracture care across 22 countries and regions, including Viet Nam. It identified substantial differences in diagnostic access, fracture surveillance, treatment availability, secondary fracture prevention, and quality improvement systems.

For Viet Nam, the audit reported limited coverage of Fracture Liaison Services and gaps in routinely reported fracture risk assessment practices and national quality indicators for fragility fracture care.

These findings require careful interpretation.

The audit does not establish that no individual Vietnamese healthcare facility uses fracture risk assessment tools or operates a coordinated fracture prevention service.

Indeed, the international Capture the Fracture program lists Vietnamese fracture liaison services on its Map of Best Practice, including Thong Nhat Hospital in Ho Chi Minh City, which has received Gold recognition under the program's Best Practice Framework. [9]

This demonstrates that coordinated secondary fracture prevention has already been introduced in selected Vietnamese healthcare settings.

However, international recognition of an individual service does not mean that such care is consistently available across the country or that the recognition constitutes a mandatory Vietnamese healthcare accreditation.

The audit also relied partly on information supplied by national experts and professional organizations. Its findings should therefore be interpreted as reported health-system indicators rather than a complete assessment of every Vietnamese healthcare facility.

The practical opportunity is to strengthen the connection between fracture recognition, clinical assessment, appropriate treatment, rehabilitation, and follow-up.

For VLMA, these findings provide useful context for professional education about the role of Lifestyle Medicine within osteoporosis care, without requiring the platform to reproduce the detailed work of specialist fracture prevention services.

What the 2026 Vietnamese Screening Study Actually Shows

A cross-sectional study published in BMJ Open on September 25, 2026, provides additional evidence relevant to bone health assessment in Viet Nam. [10]

The study examined 592 adults aged 50 years and older who attended a community bone health screening program in Kieu Phu, a rural commune of Hanoi.

Researchers used calcaneal quantitative ultrasound to assess bone status.

Among the participants, 355 people, or 60.0%, were classified as having low bone status according to the study's predefined ultrasound threshold.

Female sex and underweight status were independently associated with low bone status in the adjusted analysis.

These findings are useful, but their interpretation requires caution.

The reported 60% is not the prevalence of osteoporosis in Viet Nam.

Participants attended a particular screening program rather than being selected through a nationally representative population sample.

Their mean age was approximately 75 years, and most were aged 70 years or older. The findings therefore should not be generalized to all Vietnamese adults aged 50 years and older.

Furthermore, calcaneal quantitative ultrasound is not equivalent to DXA for the diagnosis of osteoporosis.

Although ultrasound can provide information relevant to bone health and fracture risk, T-scores generated by heel ultrasound devices are not interchangeable with standard DXA-based diagnostic thresholds.

The study identified low bone status according to its own screening definition. It did not establish that 60% of participants had confirmed osteoporosis based on conventional DXA criteria.

The researchers suggested that calcaneal ultrasound may help identify people who could benefit from further assessment where DXA access is limited.

However, the value of screening depends on what happens after an abnormal result.

People identified as potentially at risk need appropriate interpretation, further investigation when indicated, and access to relevant clinical care.

A screening program that identifies many people with potentially low bone status but cannot connect them with appropriate assessment or follow-up may have limited benefit.

For Viet Nam, this raises an important question that extends beyond the choice of screening equipment: how can people identified as being at risk receive appropriate assessment and care?

Lifestyle Support Must Be Feasible in Everyday Life

An older person recovering from a fracture may encounter difficulties that are not fully reflected in bone density measurements or clinical risk scores.

They may live in a home with stairs, slippery floors, poor lighting, or limited bathroom accessibility. Traveling to rehabilitation sessions may be difficult, and access to medication or suitable exercise facilities may depend on financial resources or family support.

These circumstances influence whether a recommended care plan can be followed.

Fear of falling can also affect recovery.

Someone who has experienced a painful fracture may gradually avoid walking outdoors, climbing stairs, or participating in social activities. Reduced movement can contribute to further muscle weakness, worsening balance, and loss of confidence.

A rehabilitation plan may therefore need to address mobility, environmental safety, confidence, and social participation alongside physical performance.

Home safety assessment may identify hazards such as inadequate lighting, loose floor coverings, obstacles, or unsuitable footwear.

Medication review may also identify treatments associated with dizziness, sedation, or postural hypotension. Vision problems, neurological conditions, and other contributors to instability may require clinical attention.

These concerns are relevant because they can influence whether someone falls and whether a fall results in serious injury.

The Lifestyle Medicine Core Competencies: 2025 Update recognizes the importance of considering social determinants of health when applying lifestyle interventions. [11]

For osteoporosis, this means recognizing that people do not have equal access to safe exercise environments, appropriate nutrition, medical investigations, medication, or rehabilitation.

An intervention may be supported by scientific evidence yet remain difficult to follow because of financial, physical, or social circumstances.

Healthcare professionals should work with patients and caregivers to identify changes that are feasible and meaningful while recognizing when additional support or service coordination is needed.

Measuring Better Care Beyond Bone Density

Bone mineral density is useful for diagnosis and treatment monitoring, but it is not a complete measure of osteoporosis care.

A patient may show improved bone density while remaining at high risk of falling. Another may have relatively stable measurements but experience a new vertebral fracture.

Clinical follow-up should therefore consider outcomes beyond the DXA report.

These may include new fractures, falls, functional ability, treatment adherence, adverse effects, and quality of life.

For patients receiving pharmacological treatment, repeat bone density assessment and selected laboratory investigations may be appropriate at intervals determined by the medication, clinical condition, and purpose of monitoring.

Small changes in DXA results require careful interpretation because differences between measurements may reflect technical variability rather than true biological change.

The International Society for Clinical Densitometry emphasizes that follow-up testing should have a defined clinical purpose and that meaningful changes should be assessed in relation to measurement precision. [1]

For healthcare organizations, quality improvement may also examine whether patients with fragility fractures receive appropriate osteoporosis assessment, whether treatment is considered or initiated when indicated, and whether follow-up actually occurs.

The distinction between documenting an activity and demonstrating its benefit is important.

Recording that someone received exercise advice does not establish that strength or balance improved. Documenting a referral does not show whether the person completed the recommended assessment or received treatment.

Similarly, prescribing an osteoporosis medicine does not guarantee that the patient understands how to use it, can obtain subsequent doses, or has a plan for managing treatment interruptions.

Patient goals should also be considered.

For some people, improvement may mean walking safely to a nearby market. For others, it may mean returning to household activities, traveling independently, or feeling more confident after a previous fall.

These outcomes matter even when they cannot be summarized by a single numerical measure.

The purpose of monitoring is to connect assessment and treatment with meaningful improvements in health, safety, and everyday life.

Professional and Legal Considerations in Viet Nam

Lifestyle Medicine can contribute to osteoporosis care through evidence-based education, support for appropriate physical activity, nutrition-related guidance, and attention to behavioral and social factors affecting health.

However, diagnosing osteoporosis, interpreting bone density results, determining fracture risk, prescribing medication, and providing specialized clinical rehabilitation are regulated healthcare activities.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides the principal legal framework for medical examination and treatment. [12]

Healthcare professionals must act within their qualifications, professional responsibilities, and legally authorized scopes of practice.

Education or certification in Lifestyle Medicine does not independently authorize a person to diagnose osteoporosis, prescribe antiresorptive or bone-forming medicines, or provide specialized therapeutic exercise outside their permitted professional scope.

Depending on the patient's needs, appropriately qualified physicians, rehabilitation professionals, clinical nutrition professionals, pharmacists, nurses, and other healthcare personnel may contribute within their respective roles.

Exercise interventions involving recent fractures, significant functional limitations, or high fall risk require particular attention to professional competence, clinical assessment, and appropriate supervision.

International recommendations from the Osteology Umbrella Association, National Osteoporosis Guideline Group, International Society for Clinical Densitometry, and Singapore's Agency for Care Effectiveness can inform professional education.

However, these recommendations do not automatically become binding Vietnamese clinical standards or establish the local approval, availability, reimbursement, or suitability of particular treatments.

Patient information also requires appropriate protection.

Fracture histories, bone density results, medication records, and other identifiable health information may contain sensitive personal data.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements for personal data processing and protection. [13,14]

For the Vietnam Lifestyle Medicine Alliance (VLMA), the appropriate contribution is professional education, scientific knowledge exchange, and responsible collaboration.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its role is to support evidence-based Lifestyle Medicine through education, professional capability development, and critical interpretation of scientific evidence.

Potential educational topics include safe physical activity for bone health, the different roles of resistance and balance training, interpretation of fracture prevention research, and understanding why medication safety and treatment continuity matter.

Such work would benefit from collaboration with appropriately qualified osteoporosis specialists, rehabilitation professionals, clinical nutrition professionals, and other relevant healthcare practitioners.

These are potential directions for education and scientific exchange, not claims that VLMA currently provides osteoporosis diagnosis, medical treatment, or clinical rehabilitation services.

The objective is to strengthen professional understanding while respecting the clinical responsibilities and expertise required for safe osteoporosis care.

Preventing the Next Fracture Is the Outcome That Matters

Osteoporosis is often identified through a bone density measurement, but its consequences are experienced through fractures, pain, reduced mobility, and loss of independence.

Appropriate resistance training, weight-bearing activity, balance exercises, and nutrition can contribute to bone and muscle health. Their effects differ, and each intervention needs to be considered according to the person's fracture risk, physical capacity, and clinical circumstances.

For people at high or very high fracture risk, established medical treatment remains an important part of care.

Medication safety involves more than preventing adverse effects. It also requires attention to treatment continuity, particularly when stopping or delaying a medicine may create additional fracture risk.

The 2026 exercise recommendations, international osteoporosis guidance, and recent evidence concerning healthcare delivery in Viet Nam reinforce the importance of considering bone strength, fall prevention, treatment, and follow-up together.

For healthcare professionals in Viet Nam, the opportunity is to connect these elements within care that is practical, evidence-based, and responsive to individual needs.

A person recovering from a fragility fracture should not be left with only general advice to eat better and exercise more. They may need assessment of underlying osteoporosis, appropriate medication, safe rehabilitation, fall prevention, and a clear follow-up plan.

Lifestyle Medicine has a meaningful role in this approach, but not by presenting exercise or nutrition as replacements for established medical treatment.

Its contribution lies in helping people maintain healthier behaviors, preserve physical function, and reduce modifiable risks within comprehensive clinical care.

The ultimate goal is not simply to improve a T-score. It is to prevent avoidable fractures and help people maintain the strength, confidence, and independence needed for everyday life.

Selected References

1. International Society for Clinical Densitometry. 2023 ISCD Official Positions—Adult. August 2023.

2. Agency for Care Effectiveness, Ministry of Health, Singapore. Osteoporosis: Diagnosis and Management. ACE Clinical Guideline. August 15, 2025.

3. Kemmler W, Schoene D, Kohl M, et al. Exercise for Fracture Prevention: Evidence and Consensus-Based Practice Guideline of the Osteology Umbrella Association (DVO). BMC Endocrine Disorders. 2026;26:98. Published February 16, 2026. DOI: 10.1186/s12902-026-02194-1.

4. National Osteoporosis Guideline Group. Clinical Guideline for the Prevention and Treatment of Osteoporosis. Updated December 2024.

5. United States Food and Drug Administration. FDA Adds Boxed Warning for Increased Risk of Severe Hypocalcemia in Patients With Advanced Chronic Kidney Disease Taking Prolia (Denosumab). January 19, 2024.

6. van der Velde N, Seppala LJ, Bahat G, et al. Position Paper: A Coordinated Approach to Fracture and Fall Prevention From Seven International Organizations. European Geriatric Medicine. Published September 10, 2026. DOI: 10.1007/s41999-026-01596-7.

7. Ministry of Health of Viet Nam. Decision No. 361/QĐ-BYT Issuing the Guidelines for Diagnosis and Treatment of Musculoskeletal Diseases. January 25, 2014.

8. Asia Pacific Consortium on Osteoporosis and International Osteoporosis Foundation. The APCO–IOF Asia Pacific Regional Audit: Epidemiology, Costs and Burden of Osteoporosis in 2025. 2025.

9. International Osteoporosis Foundation. Capture the Fracture: Map of Best Practice—Thong Nhat Hospital. Accessed October 2026.

10. Pham PT, Ha TM, Nguyen HQ, et al. Low Bone Status on Calcaneal Quantitative Ultrasound Among Community Screening Attendees in Rural Northern Vietnam: A Cross-Sectional Study. BMJ Open. 2026;16(9). Published September 25, 2026. DOI: 10.1136/bmjopen-2026-120565.

11. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. DOI: 10.1177/15598276251379821.

12. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. February 26, 2026.

13. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

14. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Articles and Measures for Implementing the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

Editorial and Professional Scope Note

This article presents the professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in osteoporosis care, including physical activity, nutrition, fracture prevention, medication safety, and healthcare coordination. It reflects scientific and regulatory information reviewed as of October 30, 2026.

The article is intended for professional information, education, and scientific knowledge exchange. It does not constitute an official clinical practice guideline, individualized medical advice, a diagnostic assessment, an exercise prescription, a nutritional treatment plan, a medication recommendation, a rehabilitation protocol, or an authoritative interpretation of Vietnamese law. The introductory scenario is hypothetical and does not describe an actual VLMA clinical activity.

Lifestyle interventions can support bone and muscle health but should not delay or replace necessary medical evaluation, fracture treatment, pharmacological therapy, or rehabilitation when clinically indicated.

Exercise recommendations require individual consideration of fracture history, physical function, fall risk, and associated conditions. People with recent fractures, significant pain, neurological symptoms, or substantial mobility limitations require appropriate clinical assessment before undertaking potentially high-risk activities.

Osteoporosis medications should not be initiated, adjusted, interrupted, or discontinued without appropriate professional guidance. In particular, denosumab should not be stopped or substantially delayed without an individualized plan addressing the risk of rapid bone loss and vertebral fractures.

References to international guidelines and regulatory communications do not imply their automatic adoption as Vietnamese clinical standards or confirm the local approval, availability, reimbursement, or suitability of particular treatments.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. It is not a licensed medical examination or treatment facility, rehabilitation service provider, medical licensing authority, or healthcare accreditation organization. VLMA does not independently diagnose osteoporosis, prescribe treatment, perform clinical fracture risk assessment, or provide individualized rehabilitation or medical follow-up.

Clinical assessment, diagnosis, prescribing, rehabilitation, and follow-up must remain under the responsibility of appropriately authorized healthcare professionals and facilities acting within their lawful scopes of practice. Patient information must be handled in accordance with applicable confidentiality and personal data protection requirements.

Scientific publications and professional recommendations are included for educational purposes. Their inclusion does not imply that VLMA has formally adopted, clinically implemented, evaluated, validated, or certified any osteoporosis treatment or Lifestyle Medicine program discussed in this article.