Osteoporosis Symptoms and Diagnosis

Osteoporosis causes your bones to become brittle and fragile, resulting in an increased risk of fractures. But most people with osteoporosis don’t know this is happening to their bones, or that they have this disease.

In fact, osteoporosis is sometimes considered a “silent disease” because of its lack of symptoms. (1)

Many people don’t learn they have osteoporosis until they break a bone from a seemingly minor fall or other accident. Doctors sometimes call these “fragility fractures.”

These bone fractures tend to heal slowly and most often occur in the spine, wrists, hips, and pelvis.

In later stages of osteoporosis, people who have it may experience:

• Back pain, possibly associated with a fracture
  
• Loss of height over time — as much as 6 inches
• Stooped posture, or forward bending of the spine due to upper spine malformations (called kyphosis)
• A bone fracture that happens more easily than expected

If you or your doctor think you may be at risk for osteoporosis, your doctor may recommend that you have your bone mineral density measured. A bone mineral density (BMD) test is the only test that can diagnose osteoporosis before you break a bone.

The most common BMD test is called DXA (also abbreviated DEXA), or dual-energy X-ray absorptiometry. The Bone Health & Osteoporosis Foundation (BHOF) recommends that DXA be performed to test the hip and spine.

A DXA test doesn’t hurt and is much like having an X-ray done, but involves less radiation exposure. (2) You’ll lie down on a padded table as your body — or usually selected body parts, such as the hip, wrist, and spine — are scanned. (3)

DXA results are given in T-scores, which compare a person’s bone mineral density to average values for healthy young women in units of standard deviation.

• Normal: T-score of -1.0 and above
• Osteopenia (low bone mass): T-score of -1.1 to -2.4
• Osteoporosis: T-score of -2.5 and below
• Severe osteoporosis: T-score of -2.6 and below with a history of fracture (4)

Your BMD, along with information about certain personal characteristics and osteoporosis risk factors, can be used to estimate your risk of having a bone fracture in the next 10 years. The tool used to estimate fracture risk is known as FRAX. (5)

The BHOF recommends having a bone density test if:

• You are a woman age 65 or older
• You are a man age 70 or older
• You break a bone after age 50
• You are a woman of menopausal age with osteoporosis risk factors
• You are a postmenopausal woman under age 65 with risk factors
• You are a man age 50 to 69 with risk factors

If you take medication to treat osteoporosis, your doctor may recommend repeating the DXA scan every one or two years. Whenever you start a new osteoporosis medication, your healthcare provider most likely will want to perform a bone density test after one year.

Note that while having low bone density — also known as osteopenia — puts you at greater risk of developing osteoporosis, it doesn’t guarantee that you will get it. Sometimes lifestyle changes, such as quitting smoking and reducing alcohol intake, can slow the rate of bone loss.

While the BHOF states that people with osteoporosis should consider drug treatment to reduce the risk of broken bones, for people with osteopenia, it suggests using FRAX to calculate a person’s fracture risk before deciding on whether to use medication. (2)

Preparing to talk about osteoporosis with your doctor in advance can help to make sure you get your questions answered. The following are practical and proactive things you can do to make your appointment go smoothly. (3)

• Bring a notepad to your doctor’s appointment in which you’ve written down information about yourself that may be related to your condition and in which you can take notes during the appointment.
• If you have experienced symptoms, including a loss in height, write them down.
• Write down personal information that you might forget when you see your doctor, such as any major stresses or recent life changes.
• List all medications, vitamins, and supplements — and, if possible, their doses, frequencies,  and length of treatments — that you take now or have taken in the past (especially any related to osteoporosis). You can also just bring the bottles with you for current drugs or supplements.
• Jot down all the questions you have for the doctor in order of most important to least, in case there isn’t enough time to answer them all.
• Prior to the appointment, find out if you have a first-degree relative (such as a mother or sister) with osteoporosis or other bone issues.
  

Not sure what to ask your doctor about osteoporosis? Mayo Clinic recommends the following questions:

• Do I need to be screened for osteoporosis?
• What kinds of tests do I need?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Is there a generic alternative to the medicine you’re prescribing me?
• Are there any alternatives to the primary approach that you’re suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any exercise restrictions that I need to follow?
• Do I need to make changes in my diet?
• Do I need to take supplements?
• Is there a physical therapy program that would benefit me?
• What can I do to prevent falls?

Aside from the questions you prepare ahead of time, be sure to ask questions that come to mind during your visit with your doctor.

Also, be ready to answer some questions from your doctor, such as the following: (3)

• Have you experienced any fractures or broken bones?
• Have you noticed that you are shorter?
• How is your diet, especially dairy intake? Do you think you get enough calcium? Vitamin D?
• What vitamins or supplements do you take?
• Do you exercise? What type and how often?
• How is your balance? Have you experienced any falls?
• Do you have a family history of osteoporosis?
• Has anyone in your family experienced bone fractures? Have either of your parents had a hip fracture?
• Have you ever had stomach or intestinal surgery?
• Have you ever taken a corticosteroid medication, like prednisone or cortisone? If so, did you take it in the form of a pill, injection or cream? And for how long?

If you are diagnosed with osteoporosis, remember that treating it may involve numerous, simultaneous approaches — including lifestyle changes as well as drug therapy — and that your doctor will want you to check in periodically to see what effect your treatment is having and whether changes in treatment might be necessary.