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Osteoporosis

How do doctors diagnose osteoporosis?

Your doctor may think you have osteoporosis just from talking with you and examining you. But you will probably need a scan to say for sure.

Here are some of the things that may make your doctor think you have osteoporosis.

You broke a bone very easily, especially one in your spine, hip or wrist.
You are a woman who has been through

menopause
When a woman stops having periods, it is called menopause. This usually happens around the age of 50.

menopause and you are getting shorter or your spine is curving forward.
You have lots of risk factors that make it more likely that you will get osteoporosis. For example, you are a woman who has been through menopause, and your mother had osteoporosis, and you have small bones and are thin (you weigh less than 88 pounds).

Source:
Espallargues M, Sampietro-Colom L, Estrada MD, et al.
Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature.
Osteoporosis International. 2001; 12: 811-822.

¹

If your doctor thinks you have osteoporosis, he or she will want to measure your bone mineral density. This is called BMD for short. It tells how much

calcium
Calcium is an important mineral in your body. It helps to make your bones and teeth strong. It also keeps your heart, nerves, muscles and blood working properly.

calcium and other minerals you have packed in your bones. The more you have, the stronger (denser) your bones are.

DEXA scans and other scans

The most common type of scan to measure your BMD is called a DEXA scan. That's short for dual-energy X-ray absorptiometry.

You may need to go to a clinic for this scan. But you will go home the same day. You may have to put on a hospital gown. But in some clinics, you can keep your own clothes on.

For this scan, you just lie on a table while the machine moves over your body. It won't touch you and you won't feel anything. The scan takes just five minutes to ten minutes. It uses radiation to measure how strong your bones are. But you get less radiation from a DEXA scan than you do from a regular X-ray.

This scan is the most reliable one for saying if you have osteoporosis. And it is the best test for measuring BMD.

Source:
American College of Radiology.
Osteoporosis and bone mineral density: ACR appropriateness criteria.
August 2008. Available at http://www.guideline.gov (accessed on 8 August 2008).

There are other, smaller scanning machines. These measure the BMD in your smaller bones, like the ones in your fingers, wrists or heels. These scans are usually used just to see if you might have osteoporosis. They are not as reliable as a DEXA scan. You may have these first if your hospital or clinic doesn't have a DEXA scanner. For more, see Other scans to measure bone mineral density.

Tests of your BMD can't say for sure if you will break a bone or not. They can only say how strong or weak your bones are. You may never break a bone, even if your bones are weak. And you can still break a bone even if your bones are strong. Experts think that only half of all fractures caused by osteoporosis could be predicted by DEXA scans.

Source:
National Screening Committee.
Osteoporosis screening.
July 2006. Available at http://www.library.nhs.uk/screening (accessed on 8 August 2008).

Who should have a DEXA scan?

In the United States, experts say that all women should have a DEXA scan when they turn 65, even if they don't have any of the things that make osteoporosis more likely.

Source:
National Osteoporosis Foundation.
Physician's guide to prevention and treatment of osteoporosis.
2003. April 2003. Available at http://www.guideline.gov (accessed on 11 August 2008).

⁴ This is because osteoporosis is common in women at that age.

Doctors agree that you should have a DEXA scan if:

Source:
National Osteoporosis Foundation.
Physician's guide to prevention and treatment of osteoporosis.
2003. April 2003. Available at http://www.guideline.gov (accessed on 11 August 2008).

⁴

You have already broken a bone after a small bump or fall
You take

corticosteroids
Corticosteroids are substances that your body produces naturally. But they can also be made in a laboratory to treat certain conditions. Corticosteroids have many different effects, including helping your body to use sugar and to control the amount of fluid it retains. They also reduce inflammation in the body, which is why they are sometimes used to treat diseases like asthma. (Asthma is caused by inflammation in the tubes that carry air in the lungs.)

corticosteroid pills regularly (this can make your bones weak)
You are a woman who had menopause before the age of 45 or had your

ovaries
Women have two ovaries, one on each side of their womb. They are small glands that store eggs. Inside the ovaries are millions of pre-eggs, called follicles. Some of these grow into eggs.

ovaries taken out before the age of 45
You are a woman who has missed menstrual periods (except when you were pregnant or after menopause) for more than a year (this could happen because of

anorexia
Anorexia is an eating disorder. People who have anorexia starve themselves because they think they are too fat. They do this even when they are very thin. It is most common among teenage girls. Doctors may call it anorexia nervosa.

anorexia or

bulimia
Bulimia is a psychological illness. People who have it tend to eat too much at one time (called bingeing) and then do something to keep from gaining weight. For example, they may make themselves throw up or do too much exercise.

bulimia, or exercising too much)
You are a man who has low levels of a

hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone estrogen is made in a woman's ovaries. Estrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.

hormone called

testosterone
Testosterone is a sex hormone. When boys go through puberty, testosterone causes the development of male characteristics like a deep voice and a muscular body. Testosterone is also known to affect men's sex drive and mood. Although testosterone is thought of as a 'male hormone', women also make testosterone (although they make much less of it then men).

testosterone
You have other conditions that cause weak bones (these include conditions called malabsorption syndrome and hyperparathyroidism)
You have had to stay in bed for a long time
You are a woman and your mother broke her hip.

If you are aged 65 or older, Medicare will pay for BMD testing every two years if:

You are especially likely to get osteoporosis
Your spine is not normal
You have been taking corticosteroid pills for a long time (or you plan to)
The glands in your neck called parathyroid glands are too active
You are taking a drug to treat osteoporosis and your doctor wants to see if it's working.

What does a DEXA scan tell you?

A DEXA scan gives lots of information about your bones. The part doctors usually use to diagnose osteoporosis is called a T score. It measures how dense (strong) your bones are compared with the bones of an average young, healthy adult.

Source:
World Health Organization.
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis.
World Health Organisation, Geneva. Technical Report Series. 1994; 843: 1-129.

⁵

A score of 1 to -1 means your bones are normal.
A score of -1 to -2.5 means your bones are a bit weak. This is called osteopenia.
A score below -2.5 means you have osteoporosis.
A score below -2.5 when you have already had a broken bone because of osteoporosis means you have severe osteoporosis.

Even if you have a score below -2.5, your doctor may want to do some more tests to be sure you have osteoporosis. These tests check for other illnesses that can cause weak bones. Here are some examples of those illnesses.

Source:
American Academy of Orthopaedic Surgeons.
Osteoporosis.
July 2007. Available at http://orthoinfo.aaos.org (accessed on 8 August 2008).

⁶

Osteomalacia. With this condition, your body doesn't have enough

vitamin D
Your body uses vitamin D to help make strong, healthy bones. You can get vitamin D from some foods, such as egg yolks and some dairy products. And your skin makes vitamin D when it is exposed to sunlight.

vitamin D to keep your bones strong.
Hyperparathyroidism. With this one, glands in your neck called parathyroid glands make too much of a hormone called parathyroid hormone. It controls how much

calcium
Calcium is an important mineral in your body. It helps to make your bones and teeth strong. It also keeps your heart, nerves, muscles and blood working properly.

calcium is in your bones and blood. If you have too much of this hormone, your body may take calcium out of your bones, making them weak.

Source:
National Endocrine and Metabolic Diseases Information Service.
Hyperparathyroidism.
May 2006. Available at http://endocrine.niddk.nih.gov/pubs/hyper/hyper.htm (accessed on 8 August 2008).

⁷

If you have a score of -1 to -2.5, called osteopenia, your bones are a bit weak. But they are not as weak as in osteoporosis.

Your doctor probably won't give you any drug treatment for osteopenia. But he or she may advise you how you can help yourself. For example, you may be advised to get more calcium and vitamin D, and to exercise.

Source:
Raisz LG.
Clinical practice: screening for osteoporosis.
New England Journal of Medicine. 2005; 353: 164-171.

⁸ These things may help make your bones stronger. For more, see Preventing osteoporosis.

Some doctors use a different score from your DEXA scan to say how strong your bones are. That one is called a Z score. It compares your BMD with the average for someone the same age as you.

How often should I have a DEXA scan?

We don't know for sure how often you should have a DEXA scan. But some doctors think you should have one:

Source:
American Association of Clinical Endocrinologists
Medical guidelines for clinical management of post-menopausal osteoporosis
Endocrine Practice. 2003; 9: 544-564.

⁹

Every two years to three years if you have osteopenia
Every three years to five years if you have a normal BMD.

If you have osteoporosis and are getting treatment, your doctors may use DEXA scanning to see if your treatment is working.

Source:
American Association of Clinical Endocrinologists
Medical guidelines for clinical management of post-menopausal osteoporosis
Endocrine Practice. 2003; 9: 544-564.

⁹ You may have a scan every year for the first two years. After that, you may have a scan every two years.

Sources for the information on this page:

Espallargues M, Sampietro-Colom L, Estrada MD, et al.Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature.Osteoporosis International. 2001; 12: 811-822.

American College of Radiology.Osteoporosis and bone mineral density: ACR appropriateness criteria.August 2008. Available at http://www.guideline.gov (accessed on 8 August 2008).

National Screening Committee.Osteoporosis screening.July 2006. Available at http://www.library.nhs.uk/screening (accessed on 8 August 2008).

National Osteoporosis Foundation.Physician's guide to prevention and treatment of osteoporosis.2003. April 2003. Available at http://www.guideline.gov (accessed on 11 August 2008).

World Health Organization.Assessment of fracture risk and its application to screening for postmenopausal osteoporosis.World Health Organisation, Geneva. Technical Report Series. 1994; 843: 1-129.

American Academy of Orthopaedic Surgeons.Osteoporosis.July 2007. Available at http://orthoinfo.aaos.org (accessed on 8 August 2008).

National Endocrine and Metabolic Diseases Information Service.Hyperparathyroidism.May 2006. Available at http://endocrine.niddk.nih.gov/pubs/hyper/hyper.htm (accessed on 8 August 2008).

Raisz LG.Clinical practice: screening for osteoporosis.New England Journal of Medicine. 2005; 353: 164-171.

American Association of Clinical EndocrinologistsMedical guidelines for clinical management of post-menopausal osteoporosisEndocrine Practice. 2003; 9: 544-564.

This information was last updated on Apr 21, 2009

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