Osteoporosis

Diagnosis

Who Should Be Tested?

The United States Preventive Service Task Force recommends that women aged 65 and older be screened (tested) for osteoporosis, as well as women aged 60 and older who are at increased risk for an osteoporosis-related fracture. However, the decision of whether or not to have a bone density test is best made between a patient and his or her physician.

Medicare will usually cover the cost of a bone density test, and a follow up test every 2 years, for female beneficiaries. It also will cover screening and follow up of any male Medicare recipients who have significant risk factors for osteoporosis.

When To Talk With a Doctor

Consider talking to your doctor about being evaluated for osteoporosis if

  • you are a man or woman over age 50 or a postmenopausal woman and you break a bone
  • you are a woman age 65 or older
  • you are a woman younger than 65 and at high risk for fractures
  • you have lost height, developed a stooped or hunched posture, or experienced sudden back pain with no apparent cause
  • you have been taking glucocorticoid medications such as prednisone, cortisone, or dexamethasone for 2 months or longer or are taking other medications known to cause bone loss
  • you have a chronic illness or are taking a medication that is known to cause bone loss
  • you have anorexia nervosa or a history of this eating disorder.
  • you are a premenopausal woman, not pregnant, and your menstrual periods have stopped, are irregular, or never started when you reached puberty.

Diagnosing Osteoporosis

Diagnosing osteoporosis involves several steps, starting with a physical exam and a careful medical history, blood and urine tests, and possibly a bone mineral density assessment. When recording information about your medical history, your doctor will ask questions to find out whether you have risk factors for osteoporosis and fractures.

The doctor may ask about

  • any fractures you have had
  • your lifestyle (including diet, exercise habits, and whether you smoke)
  • current or past health problems
  • medications that could contribute to low bone mass and increased fracture risk
  • your family history of osteoporosis and other diseases
  • for women, your menstrual history.

The doctor will also do a physical exam that should include checking for loss of height and changes in posture and may include checking your balance and gait (the way you walk).

Bone Density Tests

The test used to diagnose osteoporosis is called a bone density test. This test is a measure of how strong -- or dense -- your bones are and can help your doctor predict your risk for having a fracture. Bone density tests are painless, safe, and require no preparation on your part.

Bone density tests compare your bone density to the bones of an average healthy young adult. The test result, known as a T-score, tells you how strong your bones are, whether you have osteoporosis or osteopenia (low bone mass that is not low enough to be diagnosed as osteoporosis), and your risk for having a fracture.

Some bone density tests measure the strength of the hip, spine, and/or wrist, which are the bones that break most often in people with osteoporosis. Other tests measure bone in the heel or hand. Although no bone density test is 100 percent accurate, it is the single most important diagnostic test to predict whether a person will have a fracture in the future.

The most widely recognized bone density test is a central DXA (dual-energy x-ray absorptiometry) scan of the hip and spine. This test shows if you have normal bone density, low bone mass, or osteoporosis. It is also used to monitor bone density changes as a person ages or in response to treatment.