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

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.²

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.³

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

Doctors agree that you should have a DEXA scan if:⁴

• You have already broken a bone after a small bump or fall
• You take 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 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 or bulimia, or exercising too much)
• You are a man who has low levels of a hormone called 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.

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.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.⁶

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

We don't know for sure how often you should have a DEXA scan. But some doctors think you should have one: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.⁹ You may have a scan every year for the first two years. After that, you may have a scan every two years.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.