Understanding Osteoporosis

While osteoporosis is not curable, it is treatable. There are many steps you can take to manage the disease and reduce your chance of breaking a bone. It is important to work with your healthcare provider to learn about your risk for osteoporosis and broken bones.

A medical evaluation to diagnose osteoporosis and estimate your risk of breaking a bone may involve one or more of the following steps:

• Medical history
• Physical examination
• Bone density test
• FRAX® score
• Laboratory tests

Additional tests to learn information about your bone health may include:

• X-rays
• Vertebral fracture assessments (VFAs)
• Bone scans

Medical History. Your healthcare provider will ask questions to better understand your risk. He or she may look at the following factors:

• Your age
• Your gender
• Whether you have reached menopause (women)
• Your personal history of broken bones as an adult
• Your family history of broken bones and osteoporosis
• Whether you smoke or drink too much alcohol
• Your dietary habits, including how much calcium and vitamin D you get
• Your exercise and physical activity habits
• Whether you have had an eating disorder such as anorexia nervosa
• Whether you have had regular periods (premenopausal women)
• Your testosterone levels (men)
• Whether you take any medicines or have any medical conditions that may cause bone loss

Physical Examination. Your healthcare provider may measure you to see if you have lost height and examine your spine to see if it is curving forward. After the age of 50, you should have your height checked without shoes every year at the same healthcare provider’s office. 

Bone Density Test. A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. NOF recommends a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.

FRAX®. If your bone density test shows that you have low bone density (osteopenia), the fracture risk assessment tool called FRAX® can help estimate your chance of breaking a bone within the next 10 years. This makes it easier to decide whether you might benefit from taking an osteoporosis medicine. The FRAX® tool uses information about your bone density and other risk factors for breaking a bone to estimate your 10-year fracture risk.

If you have low bone density, your DXA report may include your FRAX® score along with your bone density. If it doesn’t, your healthcare provider can find out your FRAX® score using a web-based version. The FRAX® tool can be used to guide decisions about treatment in people who meet the following three conditions:

1. Postmenopausal women or men age 50 and older
2. People with low bone density (osteopenia)
3. People who have not taken an osteoporosis medicine

Laboratory Tests. Laboratory tests of the blood and urine can be used to identify possible causes of bone loss. Some of these tests include:

• Blood calcium levels 
• 24-hour urine calcium measurement
• Thyroid function tests
• Parathyroid hormone levels
• Testosterone levels in men
• 25-hydroxyvitamin D test to determine whether the body has enough vitamin D
• Biochemical marker tests, such as NTX and CTX

Some of the tests listed above can help to identify if you have another medical condition that is causing bone loss. This is also called secondary osteoporosis. Depending on your symptoms and other risk factors, your healthcare provider may want to test you for other conditions that can cause bone loss. If you have another condition that is causing bone loss, treating that condition will usually help your bone health. But, for many people, there is often no known cause for their bone loss or osteoporosis.

Biochemical marker tests. Biochemical marker tests of the blood and/or urine may help to estimate how fast you’re losing or making bone. These tests may also be used to see if your bone is responding well to treatment with a new osteoporosis medicine. While biochemical marker tests can be useful, they are not standard at this time. Also, these tests cannot be used to diagnose osteoporosis.

X-Rays. When osteoporosis results in multiple broken bones in the spine, the spine shortens and height loss or posture changes can occur. Breaks in the spine are also called compression fractures or vertebral fractures. After a person breaks bones in the spine, the posture may appear “stooped” or “hunched.” These posture changes are known as kyphosis. When it is severe, it is also called a Dowager’s hump. Some people feel no pain after they break one or more bones in the spine.

Your healthcare provider may suggest an x-ray of your spine if you:

• Lose 1/2 inch or more in height in one year
• Have stooped or hunched posture
• Develop back pain
• Experience a height loss of 1 ½ inches or more from your original height

Because x-rays can only detect bone loss after 25 - 40 percent of bone density is lost, these tests are not used to diagnose osteoporosis.

Vertebral Fracture Assessments (VFAs). VFAs can also show breaks in the spine. A VFA is performed on a central DXA machine and uses less radiation than a standard x-ray. Your healthcare provider may order this test if he or she suspects you have a broken bone in your spine.

Nuclear bone scans, CT Scans or MRIs. These tests can show changes that may be caused by cancer, bone lesions, inflammation, new broken bones or other conditions. They are often used to help find the cause of back pain or to follow up on abnormalities seen on an x-ray. These tests are not used to diagnose or look for osteoporosis, although many people incorrectly use the term “bone scan” to describe a bone density test.

Treatment

After reviewing the results of your medical history, physical examination, bone density test and any other tests related to your bone health, you and your healthcare provider can develop a plan to protect your bones. If you have already broken a bone due to osteoporosis, you can take steps to slow or stop bone loss and prevent broken bones in the future.

Most people with osteoporosis need to take an osteoporosis medicine to prevent broken bones. If you have osteoporosis or have broken a bone, your healthcare provider may also refer you to a physical therapist (PT). A PT who works with osteoporosis patients can teach you safe exercises to improve your strength, balance and posture. A PT can also help you prevent falls and broken bones. 

Additional Related Topics

Factors that Put You At Risk - information about medicines and medical conditions that could lead to bone loss.

Having a BMD Test - information about bone density testing, and understanding what your results mean.

Medicines that May Cause Bone Loss - information about medicines that may cause bone loss.

Diseases and Conditions that May Cause Bone Loss - information medical conditions that may bone loss.