Bone density testing — what the numbers mean

Reviewed by a board-certified medical writer specializing in geriatric orthopedics and rehabilitation medicine

Bone fractures in older adults heal 50 to 100 percent slower than in younger people, and the complications during recovery, including blood clots, deconditioning, and infection, are often more dangerous than the break itself. This article explains the biology of slow healing, the most common fracture sites and their implications, the complications to watch for, and how to support your parent through a recovery that will take longer than either of you expected.

Aging Bodies Heal Fractures on a Different Timeline

A fall in the kitchen. A slip on the stairs. A minor collision that would barely be a bump at 45 becomes a broken bone at 75. When your parent fractures something, the whole family pivots around that injury. You are suddenly coordinating medical appointments, helping them move around the house, rearranging your work schedule. The thing that surprises most adult children is how long recovery takes. Weeks turn into months. Your parent still cannot put weight on the injured leg. Their wrist is still in a cast. They are still moving slowly, still in pain. You wonder if something is going wrong, if healing has stalled. Often, the answer is both simpler and more complicated: they are healing at the pace their aging body can manage, which is slower than either of you expected.

Bone is a living tissue. When it fractures, the body activates a healing response. Bone cells start dividing and creating new bone to bridge the gap. Blood vessels grow into the area. Inflammation is part of the process. In younger people, this is relatively quick and efficient. A simple fracture might heal in six to eight weeks. In older adults, nearly everything about this process is slower. The bone cells divide less readily. The production of bone-forming cells decreases with age. Blood flow to the injury site is weaker. According to the NIH, fracture healing in adults over 65 typically takes 50 to 100 percent longer than in younger adults, meaning a fracture that heals in eight weeks for a 30-year-old might take 12 to 16 weeks or longer for a 75-year-old. This is not a sign that anything is wrong. It is how aging bodies work.

Several factors make healing even slower in some older adults. Nutritional status matters enormously. Your parent needs adequate protein, vitamin C, vitamin D, and calcium to build new bone. If they were not eating well before the fracture, or if pain or medication side effects are reducing appetite now, healing slows further. Smoking significantly slows healing. Diabetes interferes with bone healing. A history of osteoporosis means the bone was already compromised before the fracture. The NIH reports that osteoporosis affects approximately 10 million Americans over 50, and another 44 million have low bone density, making fracture risk and impaired healing widespread in the older population.

Chronic pain medications, while necessary for function during healing, come with trade-offs. Opioid pain medications can cause constipation, confusion, dizziness (which increases fall risk while your parent is already vulnerable), and suppress appetite. These trade-offs often make sense: if your parent is in so much pain they cannot participate in physical therapy, pain medication helps them participate in recovery. But understanding the full picture matters.

The Fractures That Matter Most in Older Adults

Hip fractures are the most serious and most common fractures in older adults. According to the CDC, over 300,000 adults aged 65 and older are hospitalized for hip fractures each year. A fall, or sometimes just the stress of standing and walking on weakened bone, can break the femur near the hip joint. Hip fractures almost always require surgery. Recovery is long and complicated because hip fractures often involve significant blood loss, risk of blood clots, and the physical trauma of surgery in someone who might already be medically fragile. The NIH reports that approximately 20 percent of older adults who suffer a hip fracture die within one year, and up to 50 percent of survivors never regain their previous level of mobility and independence. Your parent will likely need several months of physical therapy.

Wrist fractures are incredibly common, especially in people with osteoporosis. When someone falls, their instinct is to catch themselves with an outstretched hand, and that force can fracture the wrist bones. These fractures sometimes need surgery but often can be treated with a cast or splint. The tricky part is that a person needs their wrists for essentially everything: eating, dressing, bathing, using the toilet. A wrist fracture in an older adult can create weeks of dependence on someone else for daily activities.

Spine fractures deserve special mention. Your parent might fracture a vertebra from a fall, or sometimes just from the stress of daily activity if their bones are very weak. The NIH reports that vertebral compression fractures affect roughly 25 percent of postmenopausal women, and many occur without a fall or obvious injury. A spine fracture can be incredibly painful and might require a brace or surgery depending on severity and stability. Recovery is long, and neurological symptoms are possible if the fracture affects the spinal cord.

Pelvis fractures are also common after falls. The pelvis is essential for walking and sitting, so fractures here are particularly problematic. Recovery takes months, and older adults often lose significant mobility during that time.

The Complications Are Often More Dangerous Than the Break

The actual break healing more slowly is often not the most serious risk. Complications can turn a straightforward fracture into a much bigger problem.

Blood clots are a significant risk, especially after hip fractures or hip surgery. Immobility increases clot risk, and the trauma of the fracture and surgery compounds it. According to the NIH, without preventive treatment, deep vein thrombosis (DVT) occurs in 40 to 60 percent of patients after hip fracture surgery. A DVT is painful and treatable with blood thinners. If a clot travels to the lungs (pulmonary embolism), it is life-threatening. Doctors routinely prescribe blood thinners to prevent clots after certain fractures and surgeries.

Infection is a concern, especially with fractures that break the skin (open or compound fractures). An infection in bone (osteomyelitis) is serious and can require months of antibiotics or surgery to remove infected bone.

Non-union happens when bone fragments do not fuse back together. There can be various reasons: the pieces are not aligned properly, there is movement at the fracture site, blood supply is inadequate, or the body is not forming bone well. Non-union is more common in older adults and might require surgery to realign the pieces or add bone graft.

Deconditioning is probably the most common complication, and it often gets overlooked. When your parent has severe pain, they stay still. When they are immobilized with a cast or are bedridden after surgery, they cannot exercise. Within days of immobility, muscles start to atrophy. According to the NIH, older adults can lose 10 to 15 percent of muscle mass after just two weeks of bed rest. Strength decreases. Balance gets worse. By the time they are ready to start moving again, they are weaker than they have ever been. Recovery becomes complicated by both the fracture and significant deconditioning.

Supporting Your Parent's Recovery

Your parent's healing requires nutrition at a level they might not have maintained before. Protein is essential for building new bone and maintaining muscle. Vitamin D helps the body absorb calcium. Calcium is the mineral that makes up bone. Vitamin C is needed for collagen formation. If your parent is not eating well, their healing will slow further.

This might mean advocating for proper nutrition in ways that feel pushy. Your parent might not feel like eating. They might say they are not hungry or that food does not taste good. But feeding them well is one of the most direct ways you can support healing. Protein-rich foods do not have to be complicated: eggs, yogurt, cheese, milk, beans, peanut butter, nuts, lean meats. Milk and fortified juice provide calcium. Fatty fish like salmon provides vitamin D. If regular meals feel overwhelming, frequent small snacks add up. If swallowing is difficult, smoothies provide nutrition easily.

Physical therapy during fracture recovery is absolutely essential, and your parent will likely resist it because it hurts. Movement creates pain. They do not want to do it. But immobility creates different problems. Physical therapists know how to move joints and muscles near the fracture in ways that promote healing without disrupting the break. They teach exercises for home. They prevent deconditioning. They prepare your parent for the day they will move freely again.

Your role is often to encourage participation in physical therapy even when your parent does not want to. This is hard because you are essentially asking them to push through pain. The therapists are trained to know how much movement is helpful versus harmful. If your parent skips sessions, deconditioning accelerates. If they do the exercises at home, improvement is faster. Showing up for recovery is what actually determines how well your parent heals.

Pain management is part of recovery too. Untreated pain prevents movement, prevents sleep, prevents eating, and prevents participation in therapy. The goal is usually the lowest effective dose, transitioning to non-medication approaches as healing progresses. Ice reduces swelling early on. Heat can help with stiffness later. Over-the-counter pain relievers might be sufficient once acute pain settles. Prescription medications are often needed initially but should be tapered when possible.

Patience is the resource your parent needs most. Recovery is not fast. There will be good days and bad days. Progress is not always visible day to day. But across weeks and months, it usually happens. Your parent will move slightly more freely. The pain will decrease, sometimes imperceptibly. They will do something they could not do the previous week and not even notice until you point it out.

When Healing Stalls

Sometimes a fracture does not heal on the expected timeline. Weeks go by and the bone is not fusing. Your parent still has severe pain. Movement has not improved. X-rays show healing has not advanced as expected. This can happen for any of the reasons mentioned: infection, non-union, blood clots, nutritional deficiency, or sometimes for reasons doctors cannot fully identify.

If healing stalls, your parent will likely need additional imaging, possibly an MRI or CT scan, to understand what is actually happening. They might need blood work to check for infection or nutritional deficiencies. They might need additional treatment or surgery. This is deeply frustrating for everyone.

The important thing is to address it quickly rather than hoping it resolves on its own. If healing has not progressed by the expected timeline, that is the moment to push for additional evaluation. Stalled healing that goes unaddressed becomes a much bigger problem.

Some older adults never return to their pre-fracture function, even with optimal care. That is hard to face. Your parent might have been active and independent, and a fracture changes that trajectory. They might walk with a cane forever. They might need to move to a first-floor bedroom because stairs are too difficult. They might need help with daily activities they used to do independently. This is not failure. This is aging, accelerated by an injury. Your parent is adjusting to a body that works differently than before. So are you. That adjustment takes time and grace.

Frequently Asked Questions

How long does it take for a fracture to heal in an older adult?
According to the NIH, fracture healing in adults over 65 typically takes 50 to 100 percent longer than in younger adults. A simple fracture that heals in six to eight weeks for a younger person might take 12 to 16 weeks or longer in a 75-year-old. Complex fractures or those in patients with osteoporosis, diabetes, or poor nutrition may take even longer. Your parent's orthopedic surgeon can give a more specific estimate based on the fracture type and location.

What are the signs that a fracture is not healing properly?
Persistent or worsening pain beyond the expected timeline, inability to bear weight or use the affected limb when the doctor expected improvement, swelling or redness around the fracture site (which could indicate infection), and X-rays showing lack of new bone formation. If your parent's pain has not noticeably decreased after several weeks, or if they are not meeting the functional milestones their doctor or physical therapist described, request additional evaluation.

How can I help my parent eat better during fracture recovery?
Focus on protein (eggs, yogurt, cheese, nuts, lean meats, beans), calcium (milk, fortified juice, leafy greens), vitamin D (fatty fish, fortified foods, supplements as recommended by their doctor), and vitamin C (citrus fruits, berries, peppers). If appetite is poor, offer frequent small snacks rather than large meals. Smoothies can combine protein powder, yogurt, fruit, and milk into an easy-to-consume format. The NIH recommends that older adults recovering from fractures consume at least 1.0 to 1.2 grams of protein per kilogram of body weight daily.

Is physical therapy really necessary after a fracture?
Yes. Physical therapy is one of the most important factors in fracture recovery for older adults. The NIH and the American Academy of Orthopaedic Surgeons both recommend physical therapy after fractures to prevent deconditioning, restore strength and range of motion, improve balance, and reduce the risk of subsequent falls. Skipping physical therapy significantly increases the risk that your parent will not regain their pre-fracture function.

Should my parent take calcium and vitamin D supplements during healing?
This is a conversation for their doctor, but the NIH recommends that adults over 50 get 1,200 mg of calcium and 600 to 800 IU of vitamin D daily, and many fracture specialists recommend higher vitamin D doses during active healing. Supplements are appropriate when dietary intake is insufficient. Vitamin D deficiency is common in older adults, especially those who spend limited time outdoors, and it directly impairs fracture healing and bone density.

When should we worry about blood clots after a fracture?
Watch for swelling, warmth, redness, or pain in one leg (especially the calf), which could indicate deep vein thrombosis. Seek emergency care immediately if your parent develops sudden shortness of breath, chest pain, rapid heartbeat, or coughing up blood, as these could indicate a pulmonary embolism. The NIH reports that the risk of blood clots is highest in the first two to four weeks after a hip fracture or surgery. Your parent's doctor should prescribe preventive blood thinners if appropriate.