Osteoporosis is a common disease caused by low bone density that increases your risk of a fracture. However, osteoporosis is often preventable with regular physical activity and getting enough calcium, vitamin D, and protein. But how exactly can you keep your bones healthy?

Phoebe Ke, PA

In this Q&A, Phoebe Ke, physician assistant, Department of Orthopedics, Icahn School of Medicine at Mount Sinai, and coordinator for Own the Bone®, a nationwide program in partnership with the American Orthopaedic Association to reduce repeat fractures and improve bone health, discusses what causes osteoporosis and how to prevent it.

Why is it important to keep my bones strong as I age?
Low bone density increases fracture risk. Your bone mass and bone density peak in your 20s and 30s. Over time, as you age, bone density goes down. For some older people, bone density decreases more than others.

When bone density is low, you are at risk for fractures or broken bones. Many people can recover from fractures, but fractures can also be debilitating and dangerous, so it’s important to stay on top of bone health as you age.

What can help me prevent osteoporosis?
Maintaining muscle mass is important for osteoporosis prevention. The most effective ways to prevent osteoporosis include:

• Eating a nutritious diet with lots of calcium, vitamin D, and protein.
• Getting regular physical activity that includes weight-bearing exercises such as walking or climbing stairs, as well as simple strength training exercises for your arms, core, back, and lower body.
• Agility and balance training (examples include side-to-side exercises).
• Seeing a physical therapist.
• Taking doctor-prescribed medications that improve bone density and prevent fractures.

What are the best ways to get more calcium, protein, and vitamin D?

• Calcium-rich foods include dairy products, green leafy vegetables, and fish with small, soft edible bones that are themselves a source of good nutrients (sardines, anchovies, mackerel). If these don’t work for you, you can take calcium supplements.
• Good protein sources include chicken, fish, eggs, beans, and legumes.
• Vitamin D is typically absorbed from the sun and hard to get through food. Fatty fish like salmon are among the only foods that are rich in vitamin D. If people have insufficient vitamin D levels, they should consider taking vitamin D supplements.

What diseases can I get from having low bone density?
Osteopenia and osteoporosis are both diseases caused by low bone density. Osteopenia means your bone density is lower than normal, and osteoporosis is when bone density is even lower, causing brittle bones. Think of them as low bone density on a spectrum. In both cases, you have lower bone density and higher fracture risk, and that risk goes up with osteoporosis.

When should I see a doctor?
Osteopenia and osteoporosis are silent diseases, meaning there are no symptoms, and many people do not know they have them. Most women should start bone density screening at 65 and men at 70. You may need earlier screening if you are high risk (such as early menopause) or experienced a fracture from a minor injury or fall.

How can I get screened for osteopenia or osteoporosis?
These conditions can be diagnosed with a bone density scan, also called a DXA scan. At Mount Sinai, we offer state-of-the-art DXA bone-density testing.

Can osteopenia or osteoporosis be reversed?
Lifestyle measures can help but may not significantly increase bone density. Medications and lifestyle measures may help prevent further bone loss, reduce fracture risk, and in some cases, increase bone density. The goal of treatment is to prevent continued decline in bone density and prevent fractures.

What signs indicate I am becoming weak?
Older adults can experience muscle loss (sarcopenia). Symptoms of sarcopenia include difficulty carrying, lifting, or pushing things, or noticing muscle loss in your arms and legs. If you experience these, talk to your doctor about getting screened. Be aware of your choices in lifestyle, nutrition, and physical activity.

From steep curbs and icy sidewalks to deep, slushy puddles, New York City winters can be treacherous for ankles and feet. While boots can be fashionable, they should also provide good protection and support.

Meghan Kelly, MD, PhD

In this Q&A, Meghan Kelly, MD, PhD, a foot and ankle surgeon at the Mount Sinai Health System, shares expert tips on how to shop for winter boots that will protect your feet while getting you where you need to go.

What should I look for in a safe and supportive winter boot?
The most important feature is tread. Good traction is essential for stability on icy or slushy sidewalks. Look for thick soles with deep grooves—similar to the treads on a car tire—to reduce your risk of slipping. It’s the depth of the grooves that provides grip. Deep, wide tread patterns are key for stability on ice and snow.

Ankle stability is also important. In the Northeast, where snow and ice are common, we see an increase in falls leading to ankle fractures or sprains. These injuries are usually caused by slipping rather than the boots themselves.

How can I tell if a boot provides enough ankle support?
Boots that rise above the ankle and lace up high—like hiking boots—tend to offer the best ankle stability, which helps prevent sprains when walking on uneven or slippery ground. Reinforced material around the ankle joint is especially helpful if you’re prone to sprains or have weaker ankles.

What materials work best for winter weather?
Waterproof materials are key, but insulation and comfort matter, too. Look for rubber or waterproof synthetics around the sole and lower half of the boot, paired with a softer, insulated upper material. This combination keeps moisture out and warmth in, and will protect your feet from slush and puddles.

How can I find waterproof boots with good arch support?
That’s a common issue. Many waterproof boots sacrifice internal support for warmth and durability. In that case, orthotic insoles can help. Without proper arch support, people may develop tendonitis, plantar fasciitis, or Achilles tendon pain—especially those with flat feet or low arches.

What should I look for when shopping for orthotic insoles?
For most people, over-the-counter orthotics work well, make walking more comfortable, and reduce foot fatigue. Most insoles in footwear can be removed and replaced, even if it takes a little effort. Being able to switch them out is helpful if you use orthotics in multiple pairs of shoes.

People with flatter feet should choose insoles labeled “arch support,” while those with high arches may need lateral (outer-edge) support instead.

There are also newer 3D-printed orthotics that analyze your foot pressure and create a custom fit. These are available in some shoe stores and  are generally more expensive than other store-bought inserts. But they are less costly than prescription orthotics, which can take weeks to make.

How should winter boots fit?
Fit is extremely important. Many people need to size up about a half size to accommodate thicker socks. Always try boots on with the socks you plan to wear—wool or merino wool are best for warmth and moisture control.

A boot that is too tight can restrict circulation and increase the risk of blisters or even wounds, particularly in people with diabetes or neuropathy. Aim for a snug but not constricting fit, with enough room to wiggle your toes.

What should I look for when shopping for socks?
Choose warm, moisture-wicking materials to keep feet dry and prevent skin problems. Cold, damp conditions can worsen circulation issues and cause pain, especially for people with diabetes or Raynaud’s disease.

As the weather warms up, many people switch to flip flops, slides, and sandals. While these open-toed shoes keep feet cool, they often lack arch support, leading to foot problems like blisters and heel pain. Fortunately, there are ways to stay comfortable and stylish throughout the summer.

Meghan Kelly, MD, PhD

In this Q&A, Meghan Kelly, MD, PhD, a foot and ankle surgeon at Mount Sinai, shares expert insights on how to shop for the best supportive summer footwear.

What are some common foot problems caused by summer footwear like sandals, flip-flops, and slides?

People with flat feet, plantar fasciitis, Achilles tendonitis, or arch pain often experience flare-ups in summer because many sandals and flip flops lack proper arch support, compared with sneakers or closed-toe shoes.

It’s also difficult to wear orthotics in open footwear, which can worsen conditions like metatarsalgia (pain in the ball of the foot). Increased walking during summer vacations, especially on uneven surfaces like sand or cobblestones, can also aggravate joint pain and arthritis.

What features should I look for in flip flops, slides, and sandals to reduce strain on my arches and heels?

Look for summer footwear with arch support and a firm, inflexible sole. A good test: if you can fold the shoe in half lengthwise, it’s not supportive. Choose flip flops and sandals with rigid soles and built-in arch support.

Proper shoe sizing is also crucial—wearing the correct size improves comfort and makes arch support more effective.

If you suffer from Achilles tendon pain or heel pain, choose a sandal with a slight wedge, which mimics a heel lift used in some supportive closed shoes.

Can you recommend summer footwear that is both supportive and stylish?

Many popular brands now offer supportive sandals in fashionable styles. These options provide both comfort and aesthetic appeal, so you don’t have to sacrifice style for foot health.

Are there any strengthening or stretching exercises to help offset the effects of wearing less supportive footwear?

Yes. Two effective exercises are:

1. Plantar Fascia Stretch – Sit with your injured foot over your opposite thigh, so your legs are in a figure-four position, and pull your toes back to stretch the bottom of your foot. This simple foot stretch improves flexibility and reduces foot pain without equipment.
2. Calf Stretch – Stand on a step with one heel hanging off the back. Hold for five minutes, twice a day. Helps with plantar fasciitis, Achilles tendonitis, and heel pain.

Plantar fascia stretch (left) and calf stretch (right)

These foot strengthening and stretching exercises help reduce the strain from unsupportive shoes.

Can insoles or orthotics help in summer footwear?

Traditional orthotics are designed for closed shoes, but some adhesive arch support pads can work in open sandals. These can relieve pain in the arch and ball of the foot, especially for people with metatarsalgia. They’re a good option for making unsupportive footwear more tolerable. If you have pain in your feet, ankles, or even your knees and back, a podiatrist can determine if you need an orthotic. These are available in stores. A podiatrist can customize your orthotic to meet your individual needs.

What should I consider when buying or wearing shoes with heels?

Limit wearing high heels or stilettos for extended periods. Instead, choose high-heeled sandals with hidden platforms that reduce strain on the foot. Always match the heel height to your expected activity level. If heels are necessary, a block heel or wedge espadrilles (a light shoe typically made with canvas or cotton fiber) can be more supportive to your ankles as well.

What advice do you have for someone with bunions, bone spurs, or heel bumps?

For bunions, avoid tight or narrow-toed shoes. Look for open-toed sandals or those with soft fabric uppers to reduce irritation. People with heel bone spurs or pump bumps should consider backless shoes to avoid pressure and friction at the back of the heel.

Orthopedic surgeons specifically manage issues related to your musculoskeletal system—the system that provides form, support, stability, and movement for your body.  While the main components—muscle and bones—are fairly obvious, this system also includes cartilage, tendons, ligaments, joints, and connective tissue.

Your visit to an orthopedic surgeon might be for a chronic issue like carpal tunnel syndrome or for an acute injury like a torn meniscus, the thin fibrous cartilage in the knee.  Like most office visits, your initial visit with your orthopedic surgeon involves diagnosis and the development of a treatment plan. And it can set the stage for a life-changing procedure.

Edward Yang, MD

“I went into medicine and specialized in orthopedics because of my love of fixing things with my hands,” says Edward Yang, MD, a board certified orthopedic surgeon and Chief of Orthopedic Surgery at Mount Sinai Queens. “This combined with my passion for helping people led me to surgery and the specialty of Orthopedics. The surgery we do can truly change our patient’s life.”

And the right surgeon can make a big difference. “I provide my patients with a written diagnosis, and treatment plan. In addition, I often video a short exercise program for them to do at home. If my diagnosis and your symptoms are severe enough to warrant surgery, I provide written pamphlets on the surgery that is being planned,” he says. “Make sure your surgeon also discusses the risks, benefits, and alternatives to treatment when discussing surgery. “

In this Q&A, Dr. Yang offers some suggestions for how you can prepare for a visit with an orthopedic surgeon and for orthopedic surgery.

Prepare for the visit: Communication and planning in advance for the visit are key. Research shows the more involved you are in your care, the better the results.   The first steps are the same as for any doctor visit:  compile the information you need to give your orthopedic surgeon a good medical history, including any other conditions or past surgeries, and all of the medications you are taking.

Write it down: Write down the reason for your visit; this one step provides tremendous clarity for both you and your doctor.  It is important to focus, as much as possible, on the reason for your visit: When did the pain start? Where is the pain? What makes it hurt?  What helps? Have you had this problem before?  What is the quality of the pain?  Try not to volunteer unnecessary information. Be prepared with a written list of questions, and plan to take notes during the visit.

Bring your images: A great tip for saving time and money is to bring copies of any scans or X-rays related to the reason for your visit. Most images are available in digital format and are easily transported to your doctor’s office on a disk or USB flash drive. Don’t forget the accompanying report from the radiologist.

The physical exam: Dress comfortably in clothes that are easy to change into and out of. This is the time to ask your questions and be clear about next steps. The next steps often utilize the diagnostic tools in the orthopedic surgeon’s toolbox.

Healing from an injury or chronic orthopedic condition can be challenging, and many patients are unsure about their options for recovery. For example, will your condition require physical therapy or surgery, and when is it necessary to see a specialist?

Melissa Leber, MD

In this Q&A, Melissa Leber, MD, Associate Professor Orthopedics, and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, explains the different options patients have to relieve their pain. Dr. Leber is also Director of Player Medical Services at the US Open and Director, Division of Emergency Medicine Sports Medicine.

If I have a chronic orthopedic condition or injury, when should I see a specialist?

If you’re developing pain, whether it’s your knee or shoulder or another body part, you can try a course of anti-inflammatories, rest, and activity modification. If your pain is really debilitating—for example, if it’s greater than a three or four out of 10 on a pain scale, or it’s starting to affect your everyday life and the things you love to do—that’s when you should see a specialist.

When is physical therapy the best option, and when is surgery called for?

After evaluating the patient, we decide on whether to recommend surgery or non-operative treatments. Most of the time, we can present the patient with various options and decide on what is best for that particular patient. It depends on age, medical history, and their goals. Occasionally, surgery is 100 percent necessary to get you back to your normal function, but most of the time, surgery is elective. It’s not a black and white answer on whether you have to do surgery or have to do physical therapy. It may depend on whether you’re an athlete, how quickly you want to return to normal activity, whether you’re okay functioning at 80 percent versus 100 percent, and some of that is a personal discussion between you and your physician.

Are my age and general health important factors in choosing surgery versus physical therapy?

Your age and general health definitely affect whether we might recommend non-operative treatments versus surgery. Some of that depends on what your goals are for return to activity, and on what other conditions you may have: diabetes, high blood pressure, heart conditions, etc., Some medical problems may make you less fit for surgery. Sometimes it’s not really a choice, because, in the case of a hip fracture, for example, you may never be able to walk again without surgery. It depends on the condition.

If my orthopedist recommends surgery, what questions should I ask?

• What will the recovery time look like?
• Should I expect to be in any kind of a brace or a sling after the surgery?
• How much physical therapy will I need to return to normal?
• When should I expect to be at 80 percent functioning versus 100 percent functioning after the surgery?
• What is the success rate of this surgery? Is it a 100 percent success rate, 80 percent success rate?
• What are the risks of this surgery?
• Is it possible that I may come out of the surgery having continued pain?
• What would you do or recommend if I were your sibling or parent?

You will weigh the pros and cons of the surgery based on how much discomfort you’re in now and how much it’s affecting your everyday life. For example, a patient with knee pain may have knee arthritis as well as meniscus tearing, and we have to choose which patients we recommend for surgery, in which case we might say, “Okay, let’s focus on the non-operative treatments for now.” If you’re not doing well, we might recommend you consider surgery later. Some of that depends on how much arthritis is in the knee, and that’s a much more in-depth conversation.

What are some of the common misconceptions patients have about orthopedic surgery?

One of the biggest misconceptions we hear from patients is that they prefer not to see an orthopedic surgeon because they automatically think they’ll be recommended to have surgery, and that’s not true. Most of the time, the orthopedic surgeon will try non-operative treatments or conservative treatments rather than jumping straight into surgery. It really is a case-by-case situation. In general, you shouldn’t be afraid to go to see the specialist, because they may have great advice and ideas regarding the non-operative treatments that may help you—interventions such as injections and even platelet rich plasma and other things that we can offer.

What else should people know about physical therapy and surgery?

Going into physical therapy takes time and patience, but in general, you can work on functional correction using strength training, balance, stretching, and all the modalities that physical therapy can offer. Most of the time, physical therapy can work wonders. If you’re willing to put the time and effort in, you really can do great things with physical therapy and rehab. Try to find a therapist who you trust and connect with as physical therapy will go better. You can always switch to a different physical therapy clinic if you don’t love the place you are going. Ask your doctor for recommendations on which physical therapist or physical therapy location would be best for you.

Should I try taking medications at home?

Many patients come to see us having not tried taking any over-the-counter medications at home. Taking a few doses of anti-inflammatories known as NSAIDs—non-steroidal anti-inflammatories—can help considerably. Naprosyn or ibuprofen are different types of NSAIDs that can help a lot, even just two or three doses. Of course, check with your primary care doctor if you aren’t sure whether it is safe to take NSAIDs given your other medical problems and medications.

If my doctor tells me I need to rest, does that mean I can’t do anything?

When a doctor recommends rest after you’ve had an injury or an area of pain, it doesn’t mean complete rest. It just means sometimes doing more low impact exercise or trying to avoid over stressing that area of pain or that joint. If you have an injury or an area of pain, ask what exercises you can do, because many times there are a lot that you’re able to do to stay active. As you get older, if you stop exercising completely, you get deconditioned quite quickly, and that can hurt your recovery and your performance. I recommend trying to stick with activity but alter that activity to do something slightly different so you’re not injuring that area further.

How much strength training versus cardio should I do?

Patients shouldn’t focus on cardio 100 percent of the time. I often see patients coming in with knee or hip pain, and they walk 10,000 to 20,000 steps a day, or they run three to five miles every day. Sometimes it’s actually best to focus on resistance and strength training more than cardio. As patients get older, strength training becomes more and more important. When someone is 20 years old, they could do 80 percent cardio, 20 percent strength training. When they’re 80 years old, it should be the opposite, where they do 80 percent strength training and 20 percent cardio. If you have the capability, getting a personal trainer can be extremely helpful towards maintaining a healthy and pain-free life. They can watch your technique and help avoid injury while also making you stronger.