Symptoms and Diagnosis of Osteoporosis

A bone fracture may be the first sign of osteoporosis.

Osteoporosis is often called “the silent disease” since many people don’t have any obvious symptoms until they suddenly fracture a bone as the result of a minor bump or fall, or even from bending, lifting, or coughing. Osteoporosis can also cause one or more vertebrae (bones in the spine) to collapse. Signs of collapsed vertebrae include severe back pain, loss of height, or a stooped or hunched posture.


Your doctor will conduct a medical evaluation to diagnose osteoporosis. The evaluation may include taking a medical history to determine any risk factors, a physical exam (specifically of the spine and of your height), a bone density test, and lab tests.

When making a diagnosis, your doctor will consider a number of factors, including:

  • your age
  • your gender
  • for women, whether you have regular periods or have reached menopause; for men, testosterone levels
  • whether you have broken any 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 level of exercise and physical activity 
  • whether you have had an eating disorder such as anorexia
  • whether you take any medications or have any conditions that may cause bone loss.

A bone fracture may be the first sign of osteoporosis. (Source: 123RF)

A bone density test measures how strong your bones are. It can help predict your risk for developing a fracture. The US Preventive Services Task Force recommends a bone density test for women older than 65 and men over the age of 70. Younger individuals with increased risk factors for osteoporosis should also have their bone density assessed. How often the test should be repeated will depend on your specific results and your risk factors.

The most common bone density test is a noninvasive, painless test called dual-energy x-ray absorptiometry, or DEXA, which uses low-dose x-rays to scan the hip and spine. You will lie on a cushioned table while the scanner passes over your lower spine and hip. In most cases, you will not need to undress.

The results of the test are generally reported as a “T” and “Z” -score. A T-score compares your bone density with that of healthy young women. A Z-score compares your bone density with that of other people your age, gender, and race. With both scores, a negative number indicates you have thinner bones than average. The more negative the number, the higher your risk of a bone fracture.

According to the World Health Organization (WHO), if your T-score is:

  • -1.0 or above, you are within the normal range
  • Between -1 and -2.5, your bone density is low
  • -2.5 and below, you likely have osteoporosis

The International Society for Clinical Densitometry (ISCD) reports that a normal Z-score is above -2.0.

Another way to assess bone density is with a handheld device called the Bindex (Bone Index Finland, Ltd.). This quick and easy tool measures the thickness of the tibia (shinbone) to estimate hip density. The results, which are provided instantly, are combined with other patient data to help diagnose osteoporosis.

Blood and urine tests are not typically used to diagnose osteoporosis, but they can be used to identify other possible causes of bone loss.

If you are taking an osteoporosis medication, your doctor is likely to recommend that you repeat your bone density test every one to two years. After you start a new osteoporosis medicine, you may be advised to repeat a bone density test after one year.

Updated on: 02/25/19
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