DIAGNOSING OSTEOPOROSIS
It's important to spot osteoporosis early. Your doctor will use several tools to assess your bone health and determine whether treatment is needed.
YOUR BONE HEALTH CHECK UP
To check the status of your bone health your doctor will typically:
A broken bone after the age of 50 is one of the most serious risk factors for further fractures in the future. Other important risk factors include a family history of osteoporosis and/or fracture, frequent falling, and some diseases (such as rheumatoid arthritis, diabetes) and medications (glucocorticoids).
BONE MINERAL DENSITY (BMD) TESTING BY DXA
Traditional X-rays used to identify broken bones cannot measure BMD. BMD must be measured by more specialised techniques.
Different types of BMD tests are available, but the most established and most commonly used method is called DXA (Dual-energy X-ray Absorptiometry).
A DXA scan is a safe, quick and painless method to measure bone density. The result is given as a T-score, and this shows whether your bone mass is in the normal range, or whether you have osteopenia or osteoporosis.
See section What do my DXA Results Mean below.
Some DXA facilities or scanners may also include other assessment tests that will help to give your doctor an even more accurate assessment of your bone strength, such as Vertebral Fracture Assessment (VFA) to find fractures in your spine that you might not know about or Trabecular Bone Score (TBS) to give an (indirect) assessment of the internal structure of your spine bones.
The results of your DXA test are shown as T-scores, usually for the spine and hip. These values express your bone density in comparison to the average bone density at the same site in a healthy, young reference population. If your bone density is above the young average you will have a positive score (e.g. T-score = 1.0), but if it is below the average it will have a negative score (e.g. T-score = -1.0). The T-score can be used to determine whether your bone density is within the normal range, or whether you have low bone mass (osteopenia) or osteoporosis.
If your BMD test shows osteopenia or osteoporosis, it means that you have a higher risk of breaking a bone.
| STATUS | BMD T-SCORE (SD) |
|---|---|
| Normal | -1 and above |
| Osteopenia (low bone mass) | Between -1 and -2.5 |
| Osteoporosis | -2.5 or lower |
| Severe Osteoporosis | -2.5 or lower and presence of at least one fragility fracture |
if you have already broken a bone, or your FRAX assessment shows that your risk of fracture is high, you are considered to be at (high) risk of fracture even when the T-score is in the osteopenia range.
The need for a repeat BMD test will depend on your individual situation.
It is often repeated 1 to 2 years after starting or changing osteoporosis medication to see whether there has been a response to treatment. It might also be repeated in 1 to 2 years if you are not receiving treatment but are nearing the point where treatment might be necessary. If possible, have repeat BMD tests at the same facility.
OTHER TESTS FOR DIAGNOSIS, BONE DENSITY AND BONE HEALTH
There are other tests besides DXA that can assess your bone health which are not as commonly used and may not be available locally or reimbursed. Nevertheless, they can offer valuable information beyond bone density or help determine if a DXA scan is needed. These tests include:
An ultrasound-based technology that appears comparable to DXA in determining BMD and generating T-scores at the spine or hip. In addition, REMS allows the assessment of bone quality through the REMS-based Fragility Score (FS) parameter and the calculation of the 5-year fracture risk (FR).
Also frequently used to assess bone mass by measuring the heel or finger using sound waves. Its clinical use is limited.
Measuring bone mass at the spine or hip in a CT scanner.
Measuring bone mass at the forearm and tibia.
Doctors are now able to diagnose bone fractures more easily and accurately, especially in the spine, using AI-analysis X-rays, CT scans and other images.
NAVIGATING YOUR OSTEOPOROSIS DIAGNOSIS: NEXT STEPS
Being diagnosed with osteoporosis can be overwhelming, especially if you're unsure of what to do next. Take control of your osteoporosis diagnosis by being proactive and staying informed - don’t hesitate to ask questions.
By managing your condition effectively, you can live well with osteoporosis!
Discuss next steps with your doctor. Your doctor can provide tailored advice and recommendations based on your medical history and current health. These are likely to include changes to your lifestyle (diet, exercise etc), supplements and medication, where appropriate.
Schedule follow-up DXA scans and ensure you are comfortable with your treatment plan.
NEVER STOP TREATMENT WITHOUT DISCUSSING WITH YOUR DOCTOR FIRST! Read about Treatment
Since falls can lead to fractures, an assessment of your balance should be done. Check your home environment and take steps needed to reduce fall risks (such as removing obstacles, adding handrails etc).
- Start a safe and effective exercise regimen, tailored to your needs and abilities. Weight-bearing, muscle-strengthening, and balance exercises are the most helpful. Avoid high impact sports or activities that could lead to falls or injuries, especially if you have already suffered a spine fracture. Ask your doctor to recommend a physiotherapist who can teach you the exercises best suited to your health.
- Be sure to maintain a balanced, calcium-rich diet with enough protein and vitamin D to support bone health. Read more about nutrition for bone health.
- Reduce alcohol intake, stop smoking.
- Maintain a healthy body weight
Connecting with others who have osteoporosis can provide emotional support and shared experiences. Contact your local osteoporosis society to find patient support groups that will help you keep motivated and informed.