If your doctor suspects that you have osteoporosis — a condition that weakens bones and raises fracture risk — they may recommend a scan to measure your bone mineral density. Based on the results, you could be diagnosed with osteoporosis or osteopenia, a less severe form of bone loss. Additional tests can help your doctor identify any underlying factors contributing to bone loss.

Osteoporosis can be diagnosed by a primary care physician, though certain specialists may also manage this condition. If necessary, your doctor may refer you to a provider best suited for your situation. Doctors with experience in osteoporosis include:

• Endocrinologists — Hormone specialists
• Rheumatologists — Joint and autoimmune specialists
• Orthopedists — Bone and musculoskeletal specialists
• Gynecologists — Reproductive health specialists
• Geriatricians — Doctors who specialize in treating older people

Why Is Early Diagnosis of Osteoporosis Important?

The sooner you’re diagnosed with osteoporosis, the better. Earlier diagnosis means you’re less likely to experience broken bones. If you know you’re living with osteoporosis, you can take steps to treat it and avoid fractures and other complications.

Screening for osteoporosis usually happens in people who are over age 65 or have been through menopause. Doctors may order testing earlier, in certain situations, like if you’re under 50 but broke a bone, or if you have family members diagnosed with osteoporosis.

You also may need to be assessed if you have certain conditions, such as thyroid disease or rheumatoid arthritis, or take medications such as steroids. These factors can make you more likely to develop osteoporosis. Other aspects of your medical history may also lead your doctor to have you tested for osteoporosis before you turn 65.

How Is Osteoporosis Diagnosed?

Bone mineral density scans are the main tests used to diagnose osteoporosis. Additional tests may be recommended to help your doctor confirm the diagnosis and understand your specific needs.

Medical History

Your doctor will take a detailed medical history, asking questions about your family medical history and lifestyle habits. They’ll consider factors such as smoking, alcohol use, exercise habits, dietary patterns, and vitamin supplements. Your responses will help your doctor assess your risk factors for osteoporosis.

Your doctor may also ask you about diagnoses that may seem unrelated to osteoporosis. This information helps them get an overall view of your health and may help them choose the treatments that are best for you, if needed.

Your doctor might have you fill out forms that outline your medical history. They might then follow up with questions to get a fuller picture of your health. However, if there’s something important you feel your doctor should know or hasn’t covered, be sure to bring it up during your appointment.

Physical Exam

Your health care provider may do several physical assessments to see if you may have osteoporosis or be at risk. They’ll likely measure your height to check for height loss — losing an inch or more is a warning sign. They may check for changes associated with osteoporosis, such as:

• Shortness of breath, which could result from compression fractures in the spine
• Posture changes, such as stooping or bending forward more than you used to
• Pain, such as in the lower back, that worsens with certain movements

A physical exam can usually be done during a regular office visit. If your provider suspects a disk problem, they may order additional testing to pinpoint the cause — such as osteoporosis.

Bone Mineral Density Tests

The most common type of scan to measure bone mineral density is dual-energy X-ray absorptiometry, known as DEXA. A DEXA scan is considered the gold standard in diagnosing osteoporosis. This bone density test checks the amount of calcium and other minerals in your bones. Other types of imaging tests, such as specialized ultrasound, CT, or X-rays, may be used.

All scans are painless. Some check the entire skeleton, while others focus on one or more areas of the body, such as the spine, hip, wrist, heel, or fingers. Your doctor will give you information about where to go for DEXA and other scans, which usually aren’t done at a regular doctor’s office.

The World Health Organization (WHO) developed T-score guidelines to assess bone health and mineral density for people over 50. Doctors use these T-scores to help diagnose bone conditions:

• A T-score of minus 1 or higher is considered normal.
• A T-score between minus 1 and minus 2.5 indicates osteopenia, a condition in which bone density is lower than normal, but not low enough for an osteoporosis diagnosis.
• A T-score of minus 2.5 or lower is positive for osteoporosis.

If your T-score is minus 2.5 or lower and you’ve had at least one fragility fracture (a break from a minor fall or injury), you have severe osteoporosis.

Blood and Urine Tests

Your doctor may order blood or urine tests to check levels of calcium, vitamin D, thyroid and parathyroid hormones, or testosterone. The results of these and other tests can reveal whether another condition might be contributing to bone loss.

Although DEXA scans remain the most reliable and accurate method, researchers have explored using markers of bone turnover to diagnose osteoporosis and monitor treatment progress. Bone turnover markers, such as osteocalcin, alkaline phosphatase, C-telopeptide (CTX), and N-telopeptide (NTX), provide insights into bone activity.

Specifically, CTX and NTX levels are elevated when bone breakdown is active, indicating that bone is being resorbed by the body. In contrast, higher levels of osteocalcin and alkaline phosphatase suggest that bone formation is ongoing. Checking CTX and NTX levels in blood or urine may aid in initial diagnosis and can be repeated periodically to check the effectiveness of osteoporosis treatments.

You might be able to provide blood or urine samples at your doctor’s office, depending on their procedures and your insurance. In other cases, you may need to go to a different location. Your health care team will let you know if there are any specific instructions, such as fasting before the test.

FRAX Tool

The FRAX tool is an online calculator that helps doctors estimate your risk of developing a fracture, including major fractures, in the next 10 years. FRAX considers factors such as your age, other health conditions, lifestyle habits, and medications. Your doctor may use your FRAX score to assess your fracture risk and inform treatment decisions.

After calculating your FRAX score, your doctor will let you know if it indicates a need for further testing, additional treatments, or other steps to support your bone health. Working together, you and your health care provider can determine the best approach to strengthening your bones and boosting your quality of life.

Find Your Team

On MyOsteoTeam, the social network for people with osteoporosis and their loved ones, more than 62,000 members come together to ask questions, give advice, and share their stories with others who understand life with osteoporosis.

What tests did you have when you were diagnosed with osteoporosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.