You cannot feel osteoporosis developing, so diagnosis requires a bone density test
Osteoporosis causes bones to become thinner and more fragile, but you will not notice it happening. There are no symptoms in the early stages—no pain, no visible changes, nothing that alerts you that your bones are weakening. Many people discover they have osteoporosis only after a fracture, or during a routine screening test called a DEXA scan (dual-energy x-ray absorptiometry). This test measures bone mineral density and compares it to healthy bone density in younger adults.
A DEXA scan takes about 10 to 30 minutes, involves no injection or radiation exposure beyond a standard x-ray, and produces a report with a T-score. That T-score is the number that tells you whether your bones are normal, show early thinning (called osteopenia), or have osteoporosis. Without this test, you have no way to know your bone density status.
Key Takeaways
- A DEXA scan is the only way to know if you have osteoporosis; you cannot feel or see bone loss on your own.
- Your doctor may recommend screening based on age, sex, family history, or other risk factors—not because you have symptoms.
- A T-score of −2.5 or lower on a DEXA scan indicates osteoporosis; between −1.0 and −2.5 indicates osteopenia (early bone loss).
- If you have had a fracture from a minor fall or bump, your doctor should evaluate your bone density even if you have never had screening before.
- Some people learn they have osteoporosis only after a fracture, which is why screening matters for people at higher risk.
Who should get screened and when
Screening recommendations depend on your age and sex. The U.S. Preventive Services Task Force recommends that all women age 65 and older get a DEXA scan, and all men age 70 and older. For younger adults, screening is recommended if you have risk factors—such as a family history of osteoporosis, low body weight, use of certain medications (like corticosteroids), or conditions that affect bone health (like rheumatoid arthritis or celiac disease).
Women who have gone through menopause are at higher risk because estrogen, which helps maintain bone density, drops sharply. Some doctors recommend screening for postmenopausal women starting at age 50 if other risk factors are present. Men can develop osteoporosis too, though it typically happens later in life. If you have had a fracture from a minor fall—such as falling from standing height or bumping into furniture—that is a sign to get screened regardless of age.
Talk to your doctor about whether screening makes sense for you. They will consider your personal and family history, medications, and overall health to decide whether a DEXA scan is warranted.
What a DEXA scan result means
A DEXA scan produces a T-score, which compares your bone density to that of a healthy 30-year-old. The score is given as a number, usually between +3 and −4. Here is what the ranges mean:
| T-Score Range | What It Means |
|---|---|
| −1.0 or higher | Normal bone density |
| −1.0 to −2.5 | Osteopenia (low bone mass, early thinning) |
| −2.5 or lower | Osteoporosis |
A T-score of −2.5 or lower means your bones are significantly thinner than normal and fracture risk is elevated. Osteopenia (−1.0 to −2.5) means your bones are thinner than normal but not yet in the osteoporosis range. Some people with osteopenia never progress to osteoporosis, while others do—this depends on how quickly bone density changes over time.
Your doctor will also look at a Z-score, which compares your bone density to others your age and sex. This helps determine whether bone loss is normal for your age or faster than expected. If bone loss is unusually fast, your doctor may order additional tests to check for underlying conditions affecting bone health.
Signs that might prompt your doctor to recommend screening
Even if you have no symptoms, certain situations should trigger a conversation with your doctor about bone density testing. A fracture from a minor injury—a fall from standing height, a bump, or a cough that causes a rib fracture—suggests bones may be weaker than expected. Loss of height over time, a stooped posture, or sudden back pain can also indicate bone loss, though these are not definitive proof.
Some medications increase osteoporosis risk. Long-term use of corticosteroids (like prednisone for asthma or autoimmune conditions), certain cancer treatments, and some seizure medications can weaken bones. If you take any of these regularly, mention it to your doctor. Conditions like hyperthyroidism, inflammatory bowel disease, kidney disease, and hormonal disorders also raise risk and may warrant screening.
A family history of osteoporosis or fractures in a parent or sibling increases your own risk. If your mother or father had a hip fracture, that is particularly important to mention. Lifestyle factors matter too—smoking, heavy alcohol use, low calcium intake, and sedentary habits all contribute to bone loss.
What happens after a diagnosis
If your DEXA scan shows osteoporosis, your doctor will discuss treatment options. These typically include calcium and vitamin D supplementation, weight-bearing exercise, and sometimes medication. Medications called bisphosphonates (such as alendronate) slow bone loss and are commonly prescribed. Your doctor may also recommend a follow-up DEXA scan in one to two years to see whether treatment is slowing bone loss.
If you have osteopenia, your doctor may recommend monitoring rather than medication. This usually means repeating the DEXA scan in one to two years to see if bone density is stable or declining. In the meantime, increasing calcium and vitamin D intake, doing weight-bearing exercise, and avoiding smoking and excess alcohol can help slow bone loss.
After any diagnosis, ask your doctor about fracture risk. Some people with osteoporosis have high fracture risk and need medication, while others have lower risk and may manage with lifestyle changes alone. Your individual situation determines the right approach.
Getting a DEXA scan: what to expect
A DEXA scan is performed at a hospital, imaging center, or doctor's office. You lie on a padded table while a scanner passes over your body, usually scanning the hip, spine, and sometimes the forearm. The procedure is painless and takes 10 to 30 minutes depending on which bones are scanned. You wear regular clothes (no metal zippers or buttons in the scan area) and remove jewelry.
Radiation exposure is minimal—much less than a standard chest x-ray. You do not need to fast or prepare in any special way before the scan. Results are usually available within a few days, and your doctor will discuss them with you and explain what they mean for your health and next steps.
If you have had recent imaging with contrast dye or a nuclear medicine scan, tell the imaging center, as this can affect timing of your DEXA scan. Otherwise, there are no restrictions before or after the test.
Frequently Asked Questions
Can I have osteoporosis without any symptoms?
Yes. Osteoporosis has no early warning signs—no pain, no visible changes, nothing you can feel. Many people have significant bone loss and do not know it until they fracture a bone or have a screening test. This is why screening is important for people at higher risk.
What if my DEXA scan shows osteopenia instead of osteoporosis?
Osteopenia means your bones are thinner than normal but not yet in the osteoporosis range. Your doctor will likely recommend repeat scanning in one to two years to monitor whether bone density is stable or declining. Increasing calcium and vitamin D, doing weight-bearing exercise, and avoiding smoking can help slow further loss.
Do I need a DEXA scan if I have never broken a bone?
It depends on your age, sex, and risk factors. All women 65 and older and all men 70 and older should have screening. Younger adults should discuss screening with their doctor if they have risk factors like family history, use of corticosteroids, or conditions affecting bone health. A fracture from a minor injury is a sign to get screened regardless of age.
How often should I have a DEXA scan repeated?
If your first scan is normal, repeat screening is usually recommended every 10 years for women 65 and older and men 70 and older. If you have osteopenia or osteoporosis, your doctor will likely recommend repeat scanning every one to two years to monitor whether treatment is working or bone loss is progressing.
Can other tests besides DEXA scan detect osteoporosis?
DEXA scan is the standard test for measuring bone density. Other imaging tests like CT scans or ultrasound can provide bone information, but DEXA is the most common and is what doctors use to diagnose osteoporosis and monitor treatment over time.