How is osteoporosis diagnosed?

Dr. Aruna V. Josyula, MD
Geriatric Medicine Specialist

To diagnose osteoporosis, a radiologist will do a noninvasive bone density test that takes about 10 minutes. This test will indicate if there is osteoporosis or osteopenia, which is low bone density that is not quite to the extent of osteoporosis. Osteoporosis can also be diagnosed if there has been a fracture with a low-impact injury.

The World Health Organization (WHO) developed criteria for diagnosing osteoporosis (a bone-thinning condition that can result in bone fracture) based on a measurement of bone mineral density called a T-score. These scores are best determined by dual-energy x-ray absorptiometry (DXA). A T-score of -2.5 or lower marks the threshold for osteoporosis.

Most experts recommend DXA screening for all women ages 65 and over. Younger women at high risk of bone loss should also be screened; namely, postmenopausal women 45 to 64 who weigh 132 pounds or less and women 55 to 64 who weigh 154 or less and are not taking estrogen.

Osteoporosis is often without symptoms, and unfortunately patients may realize they have the disease only after a fall leads to a broken bone. Your doctor can screen you for this disease with a test called a DEXA scan. If you are a women who is 65 or older, your doctor will recommend that you receive this scan every two years. This scan will determine the density of your bones and can diagnose osteoporosis.

Diagnosing osteoporosis is usually done by measuring your bone density. This is usually done with a dual energy x-ray absorptiometry test (DXA or DEXA). Since your wrist, spine and hips are most likely to fracture if you have osteoporosis, DEXA will measure the amount of bone in those areas. A special type of CT scan is sometimes used to measure bone density in the spine. While regular x-rays can show fractures that have formed because of osteoporosis, they do not indicate bone density well and are not usually used to diagnose osteoporosis. Additionally, if your doctor thinks your osteoporosis is caused by something else (like Crohn's disease) you may need blood and/or urine tests to make sure there aren't any other medical conditions to take care of.

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