How Is Osteoporosis Diagnosed?

diagnosis of osteoporosis

Many people with osteoporosis do not experience any symptoms. There are no obvious signs that could raise the suspicion of having osteoporosis. This is one of the reasons why osteoporosis is often diagnosed only when a fracture occurs. 

The delayed diagnosis of osteoporosis can allow the bones to become weaker and more porous and the risk of fractures increases substantially.

Thankfully there are tests for the early detection of osteoporosis. Here is information about how osteoporosis is diagnosed. 

Diagnosis Of Osteoporosis For Early Detection

Medical history

Routine health checks and visiting your doctor regularly can help in the early diagnosis of osteoporosis of most diseases including osteoporosis. Some symptoms of osteoporosis such as pain and tenderness in the joints are often confused with the symptoms of osteoarthritis. [1]

Your doctor might recommend a few tests to rule out osteoporosis, especially if you have a family history of this condition. 

The presence of other risk factors, a physical examination and routine information such as the age of a person or lack of calcium in the diet can also allow the physician to recommend tests to detect or rule out osteoporosis. 

Laboratory tests

Laboratory tests that determine the levels of calcium and vitamin D in the blood can help in the possible diagnosis of osteoporosis.

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Regular blood tests can also help to assess the progress of patients who are using calcium and vitamin D supplements for the management of this condition. [2]

Bone density test

A bone mineral density (BMD) test measures the density of bones using a special machine. This test helps you know the density of minerals present in a certain part of the bone. 

BMD tests can be performed on different bones of the body, including the spine, hip, forearm, finger, wrist, and heel bones. [3]

There are different forms of BMD tests. The dual-energy X-ray absorptiometry (DXA) is considered most accurate. DXA is a low-radiation X-ray test that is capable of detecting even a very small percentage of bone loss.

A DXA scan is commonly used to measure the bone mineral density in the spine and hip bones.  It is the most effective technique for evaluating the risk of osteoporosis.

The DXA scan usually takes about 10 to 20 minutes. It is a painless procedure that does not involve exposure to huge amounts of radiation. During this test, the patient lies on an X-ray table and stays still while the scanner passes over their body. 

A DXA machine works like a scanner. The machine produces 2 X-ray beams; one having high energy and the other having low energy. It measures the number of rays that can pass through the bones for each beam.

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The measure gives an accurate idea of the thickness and density of the bone and helps the diagnosis of osteoporosis.

How to interpret the results of a DXA Scan? 

The result of the DXA scan is available in the form of a T-score. The T-score shows how high or low your bone density in comparison to the bone density of a young healthy adult. A lower T-score indicates weak and porous bones suggesting a higher risk of osteopenia and osteoporosis. [4]

Women above 65 years of age are advised to have a DXA scan regularly for the early detection of osteoporosis. [5]

FRAX score

The FRAX score helps in the assessment of the risk of developing osteoporosis in the future. The test estimates the 10-year fracture risk of patients by using information about their bone mineral density and the presence of other risk factors. 

The FRAX score can also estimate your risk of developing a fracture in the hip bone and your combined risk of breaking other major bones such as the spine, shoulders, or hips over the next 10 years. 

The FRAX test can help to determine the best treatment option for people having a high risk of osteoporosis-linked fractures. It is particularly recommended for men and postmenopausal women above 50 years of age. [6]

Bone Densitometry

Bone densitometry is an X-ray test that measures the density of bones quickly and accurately.  It is commonly used to detect osteoporosis and osteopenia. 

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Bone densitometry involves exposure of the body to x-rays, women who are pregnant should avoid this test. If you are using any calcium supplements, do not take the doses for 24 hours before the bone densitometry test. [7]

Peripheral scans

Peripheral scans are used to check the bone mineral density of smaller bones such as the fingers, wrists, shinbone, kneecap, and heels. These machines offer an effective alternative when DXA scans are not available. [8]

Some of the best peripheral screening tests include: [9]

  • SXA or single-energy X-ray absorptiometry
  • pDXA or peripheral dual-energy X-ray absorptiometry
  • QUS or quantitative ultrasound
  • RA or radiographic absorptiometry
  • pQCT or peripheral quantitative computed tomography

CT scan and MRI of the spine

CT scanning and MRI of the spine are performed to assess the risk of misalignment and fractures in patients diagnosed with osteoporosis. These tests help to determine the chances of developing vertebral fractures. [10]


QCT or quantitative computed tomography helps in the diagnosis of osteoporosis by measuring the density of the bones. It is usually recommended for patients undergoing treatment for osteoporosis to assess their progress.

Some other tests that can be used to assess bone health include vertebral fracture assessments (VFAs), and biochemical marker tests.

These tests do not help to confirm the diagnosis of osteoporosis. Instead, they can provide valuable clues about how healthy and disease-resistant your bones are. 

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Talk with your doctor about including blood tests, BMD tests, and bone densitometry in your routine check-up. This will help you assess any risks and adopt healthy measures to keep your bones in good condition.

You can also undergo other tests to evaluate your risk of fractures. These diagnostic methods can play a vital role in protecting you against the complications of osteoporosis such as fractures. 



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