Making a Diagnosis

A medical evaluation to diagnose osteoporosis and estimate your risk of breaking a bone may involve one or more of the following steps:

• Medical history
• Physical examination 
• Bone density test 
• FRAX® score 
• Laboratory tests 

Other tests that may be used to get information about your bone health, but are not used to diagnose osteoporosis include biochemical marker tests, x-rays, vertebral fracture assessments (VFAs), and bone scans.

Medical History

• Your healthcare provider will ask questions to better understand your risk. Factors he or she may consider include: 
• Your age
• Your gender
• Whether you have reached menopause (women) 
• Your personal history of broken bones as an adult
• Your family history of broken bones and osteoporosis
• Your smoking or drinking habits 
• Your diet, including how much calcium and vitamin D you get
• Your exercise and physical activity 
• Whether you have had an eating disorder such as anorexia nervosa 
• Whether you have had regular periods (premenopausal women)
• Your testosterone levels (men)
• Whether you take any medicines or have any medical conditions that may cause bone loss

Physical Examination

Your healthcare provider may measure you to see if you have lost height and examine your spine. After age 50, you should have your height checked without shoes every year at the same healthcare provider’s office. 

Bone Density Test

A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. NOF recommends a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.

FRAX® - The WHO Fracture Risk Assessment Tool

The FRAX® tool uses information about your bone density and other risk factors for breaking a bone to estimate your 10-year fracture risk. Your FRAX® score estimates your chance of breaking a hip as well as your combined chance of breaking a hip or other major bones over the next ten years. Other major bones include the spine, hip, forearm and shoulder.

The FRAX® tool can be used to guide treatment decisions in people who meet the following three conditions:

• Postmenopausal women or men age 50 and older
• People with low bone density (osteopenia)
• People who have not taken an osteoporosis medicine

If you have low bone density (osteopenia), your DXA report may include your FRAX® score along with your bone density. If it doesn’t, your healthcare provider can find out your FRAX® score using a web-based version.

Image used with permission of the WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield.  FRAX® is registered to Professor JA Kanis, University of Sheffield.

Laboratory Tests

• Blood and urine tests can be used to identify possible causes of bone loss. Some of these tests include:
• Blood calcium levels  
• 24-hour urine calcium measurement
• Thyroid function tests 
• Parathyroid hormone levels
• Testosterone levels in men
• 25-hydroxyvitamin D test to determine whether the body has enough vitamin D 
• Biochemical marker tests, such as NTX and CTX

Some of the tests listed above can help to identify if you have another medical condition that is causing bone loss. This is called secondary osteoporosis. Depending on your symptoms and other risk factors, your healthcare provider may want to test you for other conditions that can cause bone loss. If you have another condition that is causing bone loss, treating that condition will usually help your bone health. But, for many people, there is often no known cause for their bone loss or osteoporosis.

Other Tests to Evaluate Bone Health

Biochemical marker tests of the blood and/or urine may help to estimate how fast you’re losing or making bone. X-Rays and Vertebral Fracture Assessments (VFAs) can show breaks in the spine.

Nuclear bone scans, CT Scans or MRIs can show changes that may be caused by cancer, bone lesions, inflammation, new broken bones or other conditions. They are often used to help find the cause of back pain or to follow up on abnormalities seen on an x-ray.