Osteoporosis 1

Osteoporosis: The Diagnosis
Osteoporosis is a condition of low bone density that can

progress silently over a long period of time. If diagnosed
early, the fractures associated with the disease can often be
National Institutes of Health
prevented. Unfortunately, osteoporosis frequently remains
Osteoporosis and Related undiagnosed until a fracture occurs.
Bone Diseases ~
National Resource Center
An examination to diagnose osteoporosis can involve
2 AMS Circle
Bethesda, MD several steps that predict your chances of future fracture,
20892-3676
diagnose osteoporosis, or both. It might include:
Tel: (800) 624-BONE or
(202) 223-0344
Fax: (202) 293-2356 • an initial physical exam
TTY: (202) 466-4315 • various x rays that detect skeletal problems
Internet: www.niams.nih.gov/bone • laboratory tests that reveal important information
E-mail: NIAMSBONEINFO@
mail.nih.gov about the metabolic process of bone breakdown and
formation
The NIH Osteoporosis and • a bone density test to detect low bone density.
Related Bone Diseases ~
National Resource Center is
supported by the National Before performing any tests, your doctor will record
Institute of Arthritis and
Musculoskeletal and Skin information about your medical history and lifestyle and
Diseases with contributions from
the National Institute of Child
will ask questions related to:
Health and Human
Development, National Institute
of Dental and Craniofacial • risk factors, including information about any
Research, National Institute of fractures you have had
Diabetes and Digestive and
Kidney Diseases, NIH Office of • your family history of disease, including
Research on Women’s Health,
DHHS Office on Women’s
osteoporosis
Health, and the National • medication history
Institute on Aging.
• general intake of calcium and vitamin D
The National Institutes of Health
• exercise pattern
(NIH) is a component of the U.S. • for women, menstrual history.
Department of Health and
Human Services.
In addition, the doctor will note medical problems and
medications you may be taking that can contribute to bone
loss (including glucocorticoids, such as cortisone). He or
she will also check your height for changes and your
posture to note any curvature of the spine from vertebral
fractures, which is known as kyphosis.
Risk Factors for Osteoporotic Fracture Include:
• personal history of fracture as an adult

• history of fracture in a first-degree relative
• Caucasian or Asian race, although African Americans and Hispanic
Americans are at significant risk as well
• advanced age
• being female
• dementia
• poor health, frailty, or both
• current cigarette smoking
• low body weight
• anorexia nervosa
• estrogen deficiency (past menopause, menopause before age 45, having
both ovaries removed, or the absence of menstrual periods for a year or
more prior to menopause)*
• low testosterone levels in men
• use of certain medications such as corticosteroids and anticonvulsants
• lifelong low calcium intake
• excessive alcohol intake
• impaired eyesight despite adequate correction
• recurrent falls
• inadequate physical activity.
*Women lose bone rapidly in the first 4-8 years following menopause, making
them more susceptible to osteoporosis.
X Ray Tests
If you have back pain, your doctor may order an x ray of your spine to determine
whether you have had a fracture. An x ray also may be appropriate if you have
experienced a loss of height or a change in posture. However, since an x ray can
detect bone loss only after 30 percent of the skeleton has been depleted, the
presence of osteoporosis may be missed.
Bone Mineral Density Tests
A bone mineral density (BMD) test is the best way to determine your bone health.
BMD tests can identify osteoporosis, determine your risk for fractures (broken
bones), and measure your response to osteoporosis treatment. The most widely
recognized bone mineral density test is called a dual-energy x-ray absorptiometry
or DXA test. It is painless: a bit like having an x ray, but with much less exposure
to radiation. It can measure bone density at your hip and spine.
2
During a BMD test, an extremely low energy source is passed over part or all of
the body. The information is evaluated by a computer program that allows the
doctor to see how much bone mass you have. Since bone mass serves as an
approximate measure of bone strength, this information also helps the doctor
accurately detect low bone mass, make a definitive diagnosis of osteoporosis, and
determine your risk of future fractures.
BMD tests provide doctors with a measurement called a T-score, a number value
that results from comparing your bone density to optimal bone density. When a T-
score appears as a negative number such as -1, -2 or -2.5, it indicates low bone
mass. The more negative the number, the greater the risk of fracture.
Although no bone density test is 100 percent accurate, this type of test is the single
most important predictor of whether a person will fracture in the future.
Bone Scans
For some people, a bone scan may be ordered. A bone scan is different from the
BMD test just described, although the term “bone scan” often is used incorrectly
to describe a bone density test. A bone scan can tell the doctor whether there are
changes that may indicate cancer, bone lesions, inflammation, or new fractures. In
a bone scan, the person being tested is injected with a dye that allows a scanner to
identify differences in the conditions of various areas of bone tissue.
Laboratory Tests
A number of laboratory tests may be performed on blood and urine samples. The
results of these tests can help your doctor identify conditions that may be
contributing to your bone loss.
The most common blood tests evaluate:
• blood calcium levels

• blood vitamin D levels
• thyroid function
• parathyroid hormone levels
• estradiol levels to measure estrogen (in women)
• follicle stimulating hormone (FSH) test to establish menopause status
• testosterone levels (in men)
• osteocalcin levels to measure bone formation.
3
The most common urine tests are:
• 24-hour urine collection to measure calcium metabolism

• tests to measure the rate at which a person is breaking down or resorbing
bone.
Treatment
In addition to diagnosing osteoporosis, results from BMD tests assist the doctor in
deciding whether to begin a prevention or treatment program. Once you and your
doctor have definitive information based on your history, physical examination,
and diagnostic tests, a specific treatment program can be developed for you.
Recommendations for optimizing bone health include a comprehensive program

that consists of a well-balanced diet rich in calcium and vitamin D, physical
activity, and a healthy lifestyle (including not smoking, avoiding excessive alcohol
use, and recognizing that some prescription medications and chronic diseases can
cause bone loss). If you already have experienced a fracture, your doctor may refer
you to a specialist in physical therapy or rehabilitation medicine to help you with
daily activities, safe movement, and exercises to improve your strength and
balance.
The National Resource Center acknowledges the assistance of the

National Osteoporosis Foundation in the preparation of this publication.
Revised November 2005
For Your Information
For updates and for any questions about any medications you are taking, please contact
the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6332, a toll-free
call) or visit their Web site at www.fda.gov.

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Osteoporosis: The Diagnosis

Osteoporosis is a condition of low bone density that can

• personal history of fracture as an adult

Bone Mineral Density Tests

The most common blood tests evaluate:

• blood calcium levels

• 24-hour urine collection to measure calcium metabolism

Recommendations for optimizing bone health include a comprehensive program

The National Resource Center acknowledges the assistance of the

Revised November 2005

For Your Information

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