Screening and Diagnosing Bone Health and Osteoporosis
*Please note: This slide show represents a visual interpretation and is not intended to provide, nor substitute as, medical and/or clinical advice.
Why is screening for bone health and osteoporosis important?
Osteoporosis is often called a "silent disease".
Your bones get weaker slowly, over many years. You might not know you have osteoporosis until you break a bone.
Screening for osteoporosis can help you understand your bone health and take steps to protect it.
What is a bone density test?
A bone density test is a snapshot of your bone health. It measures your bone mass and helps assess your risk for a fracture.
If you've had a bone density test before, a repeat test can measure changes in your bone mass.
If you're being treated for osteoporosis, a bone density test can measure how well your treatment is working.
Who should get a bone density test?
You should get a bone density test if you are:
A woman age 65 or older
A man age 70 or older
A woman under 65 or a man under 70 with a high risk for a fracture
Who is at high risk for a fracture?
Some common reasons for high fracture risk are:
Breaking a bone in a minor accident
Having a parent who broke a hip
Having a medical condition that can cause bone loss, such as diabetes or rheumatoid arthritis
Being treated with certain medications, such as steroids like prednisone
What happens during a bone density test?
The "state of the art" test for bone density is a DXA scan or bone mineral density test. It's a painless test that takes 10 to 15 minutes.
As long as you're not wearing any metal (such as a zipper, underwire bra, or jewelry containing metal), you can keep your clothes on.
What happens during a bone density test?
You need to lie still, face up, on a padded table, as the arm of the scanner passes over you.
The scanner uses a very small x-ray beam to capture images of the bone in your hip and lower back. The bone in these locations is the type of bone that tends to lose density as we get older.
Is a bone density test safe?
A bone density test is safe. The scanner uses about 1/10 of the radiation to that of a chest x-ray. That’s less radiation than you’d be exposed to on a coast-to-coast flight.
What do the results of my bone density test mean?
You'll get the results of your bone density test as two scores.
The T-score tells you how your bone density compares with the average peak bone density at age 25 to 30 for people of your gender.
What do the results of my bone density test mean?
A T-score between +1 and –1 means your bone density is in the normal range.
A T-score between –1 and –2.5 means you may have low bone mass, or osteopenia.
A T-score of –2.5 or less means your bone density is at least 25% below average peak bone density.
What do the results of my bone density test mean?
The other part of your bone density test score is the Z-score. It tells you how your bone density compares with the average for people of your age and gender. The Z-score is not used to diagnose osteoporosis in adults.
How often should I have a bone density test?
Your doctor may recommend that you get a repeat DXA test every 2 years to check for changes in your bone density.
What’s my fracture risk?
Your T-score alone doesn't tell you your fracture risk. Fracture risk is also based on other factors, such as:
Your age (Fracture risk increases as you get older)
Your family history
Medical conditions you've had
Medicines you've taken
What’s my fracture risk?
You can use American Bone Health's Fracture Risk Calculator™ to estimate your fracture risk. FRAX is another tool that can help you measure your fracture risk. Both of these tools measure the risk of breaking a hip or other major bone over the next 10 years.
How is osteoporosis diagnosed?
A T-score of –2.5 or less is the threshold for being diagnosed with osteoporosis. Some experts would say that a patient has osteoporosis if they have a risk of 1 in 5 or higher of experiencing a fracture in the next 10 years.
Regardless of your T-score, medical experts say if you are a woman past menopause, or a man over 50, and you break a hip or other major bone, you have osteoporosis.
Also, if you have low bone mass and a high risk for fracture on the FRAX tool, your doctor may recommend that you begin treatment for osteoporosis.
Are there other ways to test bone density?
Another type of test uses sound waves to measure bone density. A low T-score on one of these tests may need to be confirmed on a DXA scan.
Also, some DXA machines have software that can measure Trabecular Bone Score, which can indicate bone quality.
What other tests might you need in addition to a bone density test?
Your doctor may want you to be tested for other conditionsthat can cause bone loss, such as malabsorption or abnormal calcium levels in the blood or urine.
Your healthcare team is here to help
Talk with your doctor or another member of your healthcare team if you have any questions about your test results or your osteoporosis diagnosis.
References
American Bone Health. Frequently Asked Questions. https://americanbonehealth.org/frequently-asked-questions/
American Bone Health. Heel Ultrasound is Not the Best Screening for Osteoporosis. 2020 Apr 2. https://americanbonehealth.org/bone-density/heel-ultrasound-is-not-the-best-screening/?highlight=heel%20ultrasound
American Bone Health. How Often Should I Get Tested? 2019 Feb 18. https://americanbonehealth.org/bone-density/how-often-should-i-have-a-bone-density-test/
American Bone Health. Understanding Bone Density Results. 2020 Jan 13. https://americanbonehealth.org/bone-density/understanding-the-bone-density-t-score-and-z-score/
American Bone Health. What Is Bone Density Testing? 2019 Sept 28. https://americanbonehealth.org/bone-density/what-is-bone-density-testing/
Choosing Wisely. Bone-Density Tests – When you need a test and when you don’t. https://www.choosingwisely.org/patient-resources/bone-density-tests/
Harvard Health Publishing. What's your t-score? Bone density scans for osteoporosis. Updated January 2018. https://www.health.harvard.edu/womens-health/whats-your-t-score-bone-density-scans-for-osteoporosis
Medical News Today. Ultrasound scans could boost screenings for osteoporosis. https://www.medicalnewstoday.com/articles/324580
NIH Osteoporosis and Related Bone Diseases National Resource Center. Bone Mass Measurement: What the Numbers Mean. Last reviewed Oct 2018. https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measure#f
Torborg L. Mayo Clinic Q and A: Do you need a bone density test? 2019 May 24. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-do-you-need-a-bone-density-test/
Slide Show - Screening and Diagnosing Bone Health and Osteoporosis
This slide show provides an overview of screening and diagnosis of bone health and osteoporosis. Screening for osteoporosis can help you understand your bone health and take steps to protect it. A bone density test — also referred to as a DXA scan or a bone mineral density (BMD) — is the current way to diagnose osteoporosis. It measures your bone mass, helps assess your risk for a fracture, and if you're being treated for osteoporosis, it can also measure how well your treatment is working. Watch to learn how bone density tests work and how to understand the results of your test. This slide show also provides an overview of American Bone Health's Fracture Risk Calculator™ and the FRAX tool that can help you measure your fracture risk.
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