You cannot feel osteoporosis developing
Osteoporosis has no symptoms in its early stages. You will not feel pain, notice weakness, or see any outward sign that your bones are becoming thinner. Many people discover they have it only after a fall breaks a bone that would normally stay intact — a hip, wrist, or spine — or during a routine scan ordered for another reason.
Because the condition is silent, doctors use a specific test to find it before a fracture happens. That test is called a bone density scan, and it measures how much mineral is packed into your bones compared to a healthy young adult's bones.
Key Takeaways
- A bone density scan (DEXA scan) is the only way to diagnose osteoporosis; no blood test or physical exam can detect it.
- Your doctor may recommend screening if you are a woman over 65, a man over 70, or younger but with risk factors like family history or long-term steroid use.
- The scan takes 10 to 30 minutes, involves no needles or injections, and uses a very small amount of radiation.
- Results are reported as a T-score, which compares your bone density to a healthy 30-year-old's; a T-score of -2.5 or lower means osteoporosis.
The bone density scan: what happens during the test
A bone density scan, also called a DEXA scan (short for dual-energy X-ray absorptiometry), is an imaging test that takes pictures of your bones and measures their density. You lie on a padded table while a machine passes over your body. The machine sends two X-ray beams through your bones and measures how much radiation each beam absorbs. Denser bones absorb more radiation.
The scan usually focuses on your hip, spine, and sometimes your forearm — the places where osteoporosis fractures happen most often. The whole appointment takes 10 to 30 minutes. You do not need to undress, remove metal objects, or stay still for long periods. The radiation dose is very small — less than you would receive during a cross-country airplane flight.
You can eat and drink normally before the scan. You should tell the technician if you have had a recent CT scan or nuclear medicine test, because contrast dye from those tests can interfere with the results.
Who should have a bone density scan
Your doctor may recommend a bone density scan based on your age and risk factors. The major medical organizations — including the American Academy of Family Physicians and the U.S. Preventive Services Task Force — suggest screening for all women at age 65 and all men at age 70, regardless of other risk factors.
You may be screened earlier if you have risk factors that increase your chance of bone loss. These include a family history of osteoporosis, long-term use of corticosteroid medications (like prednisone), rheumatoid arthritis, chronic kidney or liver disease, a history of broken bones as an adult, or low body weight. Women who have gone through menopause before age 45 are also at higher risk.
If you have already been diagnosed with osteoporosis, your doctor will order repeat scans every one to two years to track whether your bone density is stable, improving, or declining further.
Understanding your T-score results
Your bone density scan produces a number called a T-score. This score compares your bone density to the bone density of a healthy 30-year-old woman or man of your same race and ethnicity. The score is reported as a number, usually between +3 and -4.
Here is what the ranges mean:
| T-Score Range | What It Means |
|---|---|
| -1.0 and above | Normal bone density |
| -1.0 to -2.5 | Low bone density (called osteopenia) |
| -2.5 and below | Osteoporosis |
A negative number means your bones are less dense than the young adult standard. The more negative the number, the thinner your bones are. A T-score of -2.5 or lower is the medical definition of osteoporosis. A score between -1.0 and -2.5 means your bones are thinner than normal but not yet in the osteoporosis range — a condition called osteopenia.
Your doctor will also calculate a 10-year fracture risk using your T-score and other factors like your age and whether you have had previous fractures. This helps determine whether you need treatment or just monitoring and lifestyle changes.
What happens after diagnosis
If your scan shows osteoporosis, your doctor will discuss treatment options with you. These may include medications that slow bone loss or help rebuild bone, along with changes to diet and exercise. You will also be advised to avoid falls — through home safety changes, balance training, or vision correction — because a fall is far more likely to cause a fracture in osteoporotic bones.
If your scan shows low bone density but not yet osteoporosis, your doctor may recommend monitoring with repeat scans in one to two years, along with steps to slow bone loss: adequate calcium and vitamin D intake, weight-bearing exercise, and avoiding smoking and excessive alcohol.
Your doctor may also order blood tests to check for other conditions that cause bone loss, such as thyroid disease or vitamin D deficiency, especially if you are younger than expected for osteoporosis or if your bone loss is happening quickly.
Other tests that do not diagnose osteoporosis
A standard X-ray of your spine or hip cannot diagnose osteoporosis. X-rays show bone structure and fractures, but they cannot measure bone density accurately enough to detect early bone loss. You need a bone density scan for that.
Blood tests cannot diagnose osteoporosis either, though they can measure markers of bone turnover — substances your body releases when bone is breaking down faster than it is being rebuilt. These markers may suggest you are at risk, but they are not used to make a diagnosis on their own.
A physical exam also cannot detect osteoporosis. Your doctor cannot feel or see whether your bones are thin. The only reliable way to know is through a bone density scan.
Frequently Asked Questions
Can I have osteoporosis without any broken bones?
Yes. Most people with osteoporosis have no fractures. The condition is discovered either through screening with a bone density scan or after a minor fall causes a fracture that would not normally break a healthy bone. This is why screening is recommended even if you feel fine.
Is the radiation from a DEXA scan dangerous?
No. The radiation dose from a bone density scan is very small — about one-tenth the dose of a chest X-ray. It is safe to have the scan repeated every one to two years if your doctor recommends monitoring. Pregnant women should tell their doctor before the scan, though the risk is minimal.
What if my T-score is between -1 and -2.5?
This range is called osteopenia, or low bone density. It does not mean you have osteoporosis, but it does mean your bones are thinner than normal. Your doctor will assess your fracture risk and may recommend lifestyle changes, repeat scanning in one to two years, or medication depending on your age and other risk factors.
How often should I have a bone density scan?
If you have normal bone density, screening is recommended every 10 years for women over 65 and men over 70. If you have low bone density or osteoporosis, your doctor will order scans more frequently — usually every one to two years — to track changes and see whether treatment is working.
Can osteoporosis be reversed?
Osteoporosis cannot be completely reversed, but bone loss can be slowed or stopped with medication, adequate calcium and vitamin D, weight-bearing exercise, and fall prevention. Some newer medications can help rebuild a small amount of bone. The goal is to prevent fractures, not to return bone density to youthful levels.