You cannot feel osteoporosis developing, so diagnosis requires a bone density test
Osteoporosis causes your 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 tells you your bones are weakening. The only way to know whether you have it is through a bone density test, usually called a DXA scan or DEXA scan. This is an X-ray that measures how much mineral is packed into your bones and compares the result to a healthy young adult's bones.
Many people discover they have osteoporosis only after they break a bone from a minor fall or bump. Others find out during a routine screening. The difference between these two paths is often whether a doctor ordered the test before a fracture happened.
Key Takeaways
- A bone density test (DXA scan) is the only way to diagnose osteoporosis; you cannot feel the condition developing.
- Your doctor may recommend screening if you are a woman over 65, a man over 70, or younger with risk factors like low body weight or family history.
- The test takes 10 to 30 minutes, involves no needles, and uses less radiation than a standard chest X-ray.
- Results are reported as a T-score, which compares your bone density to a healthy young adult's; a T-score of −2.5 or lower means osteoporosis.
- If you break a bone easily or have risk factors, ask your doctor about screening even if you have no symptoms.
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 have a bone density test. For men, screening is recommended starting at age 70. Younger adults — both men and women — should be screened if they have risk factors.
Risk factors that may prompt earlier screening include a family history of osteoporosis or hip fracture, low body weight (under 127 pounds for women), smoking, heavy alcohol use, long-term use of corticosteroid medications, rheumatoid arthritis, or conditions that affect how your body absorbs nutrients. If you have had a fracture from a minor fall or bump, your doctor will likely order a test regardless of your age.
Talk to your primary care doctor about whether screening makes sense for you. They know your medical history and can assess your individual risk. You do not need to wait until you are 65 or 70 if you have reason to be concerned.
What happens during a bone density test
A DXA scan is quick and painless. You lie on a padded table while a machine passes over your body, usually scanning your hip, spine, and sometimes your forearm. The whole process takes 10 to 30 minutes depending on which bones are being measured. You remain fully clothed and do not need to remove anything except metal objects like jewelry or a belt buckle.
The radiation dose is very small — much less than a standard chest X-ray and far less than a CT scan. There are no needles, no injections, and no contrast dye. You will not feel anything during the scan. The technician will position you and ask you to hold still for a few seconds while the machine takes images.
After the test, you can return to your normal activities immediately. There is no recovery time and no side effects.
Understanding your test results: the T-score
Your bone density test result comes back as a T-score. This number compares your bone density to the bone density of a healthy 30-year-old adult. The T-score tells you how many standard deviations your bones are above or below that young adult average.
Here is how the results break down:
| T-Score Range | What It Means |
|---|---|
| −1.0 and above | Normal bone density |
| −1.0 to −2.5 | Low bone density (osteopenia) |
| −2.5 and below | Osteoporosis |
| −2.5 and below with a fracture | Severe osteoporosis |
A T-score of −2.5 or lower means you have osteoporosis. A score between −1.0 and −2.5 means you have low bone density but not yet osteoporosis — this is sometimes called osteopenia. A score above −1.0 is considered normal.
Your doctor will also calculate a 10-year fracture risk using your T-score and other factors like your age, sex, and whether you have had previous fractures. This helps determine whether you need treatment or just monitoring.
What to do if your test shows osteoporosis
If your results show osteoporosis, your doctor will discuss treatment options with you. These typically include lifestyle changes — weight-bearing exercise, adequate calcium and vitamin D intake, and stopping smoking if you smoke — and sometimes medication. Medications called bisphosphonates are commonly prescribed to slow bone loss and reduce fracture risk.
You may also have follow-up tests to check for other conditions that can weaken bones, such as thyroid problems or vitamin D deficiency. Your doctor might order blood work to rule these out.
If your results show low bone density but not osteoporosis, your doctor may recommend monitoring with another test in one to two years, along with lifestyle measures to keep your bones strong.
Preparing for your bone density test
There is little you need to do to prepare. Wear comfortable, loose clothing without metal buttons, zippers, or snaps — the technician may ask you to change into a hospital gown to avoid metal interference. Remove jewelry, watches, and belts.
Do not take calcium supplements for at least 24 hours before your test, as they can interfere with the scan. If you take other medications, ask your doctor whether you need to stop them before the test — usually you do not.
Bring your insurance card and any paperwork your doctor's office gave you. Arrive a few minutes early to complete any check-in forms.
When to ask your doctor for screening
You do not need to wait for a doctor to suggest screening. If you have any of the risk factors listed above, or if you are concerned about your bone health, bring it up at your next appointment. If you have had a fracture from a minor injury, mention that specifically — it is a strong signal that screening should happen.
If your doctor says you do not need screening but you remain concerned, you can ask for a referral to a bone health specialist or an endocrinologist. Some people also choose to pay out of pocket for a DXA scan if their insurance will not cover it, though the cost varies by location and facility.
Frequently Asked Questions
Can osteoporosis cause pain or other symptoms before a fracture?
No. Osteoporosis itself causes no pain, no visible signs, and no symptoms you can feel. Many people have it for years without knowing. Pain or height loss usually means a fracture has already occurred.
How often do I need a bone density test?
If your first test is normal, your doctor may recommend repeating it every 10 years. If you have low bone density or osteoporosis, testing is usually repeated every one to two years to monitor whether your bones are staying stable or continuing to weaken.
Is a DXA scan safe if I am pregnant?
DXA scans use very little radiation, but they are not recommended during pregnancy. If you think you might be pregnant, tell your doctor before scheduling the test. The scan can wait until after pregnancy.
What if I cannot afford a bone density test?
Ask your doctor about community health centers or hospital programs that offer reduced-cost or free screening. Some areas have mobile screening units that travel to different locations. Your doctor's office may also know of local resources.
Can I have a bone density test if I have metal implants?
Most metal implants do not interfere with a DXA scan. Tell the technician about any implants, plates, screws, or joint replacements before the test. They will work around them or scan a different area if needed.