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Osteoporosis – The Path to Diagnosis

Updated on May 07, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kelly Crumrin

Doctors diagnose osteoporosis and osteopenia with scans that measure bone mineral density (BMD). Additional tests may help the doctor identify factors that contribute to bone loss.

Osteoporosis may be diagnosed by a primary care physician or a specialist in osteoporosis. There is no one medical specialty dedicated to treating osteoporosis, but your doctor can refer you to the most appropriate specialist in your location. Some endocrinologists, rheumatologists, orthopedists, gynecologists, and geriatricians have experience treating osteoporosis.

How Is Osteoporosis Diagnosed?

Although bone mineral density scans are the main test by which osteoporosis is diagnosed, the results of a few additional tests help the doctor make better recommendations for treatment.

Medical History

The doctor will take a thorough history, asking about family medical history and lifestyle habits such as smoking, drinking alcohol, diet, and exercise. These questions help the doctor assess risk factors for osteoporosis.

Physical Exam

Your doctor may measure your height to check for height loss. They may check your spine for changes associated with osteoporosis.

Bone Mineral Density Tests

The most common type of scan to measure bone mineral density is dual-energy X-ray absorptiometry, known as DXA or DEXA. Other types of scans may include specialized ultrasound, computed tomography (CT), or different types of X-ray scans.

All scans are painless. Some scans check the entire skeleton, while others check one or more joints, such as the spine, hip, wrist, heel, or fingers.

The World Health Organization (WHO) developed thresholds for bone mineral density called T-scores. Doctors base their diagnosis on the T-scores as shown:

  • -1 or above is normal.
  • Lower than -1 and greater than -2.5 is positive for osteopenia – lower-than-normal BMD.
  • -2.5 or lower is positive for osteoporosis.
  • -2.5 or lower, plus at least one fragility fracture, is positive for severe osteoporosis.

Blood Tests

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

C-telopeptide (CTX) and N-telopeptide (NTX) are proteins known as bone turnover markers. CTX and NTX are higher when bone is actively being broken down and resorbed by the body. CTX and NTX levels may be checked during diagnosis and periodically as a way to check the effectiveness of osteoporosis treatments.

FRAX

FRAX is an online tool doctors can use to estimate your percentage risk for developing a fracture in the next 10 years. FRAX takes into account your age, other health conditions, and what medications you take. Your doctor may consider your FRAX score when recommending osteoporosis treatments.

Condition Guide

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External resources

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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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