Bone Density Testing

Overview

A bone density test is a quick, painless scan that measures how strong your bones are. It uses a low dose of X-rays to see how much calcium and other minerals are packed into your bones. This helps show if your bones are thinner or weaker than normal, which can put you at risk for fractures (broken bones).

Bone density testing is very common, especially for people over 50. Doctors often recommend it if you have had a fracture after a minor fall, if you have risk factors for bone loss, or if you are going through or past menopause.

Anyone can have low bone density, but it is most common in older adults, especially women after menopause. Men can also have low bone density as they age, and some younger people may need testing if they have long-term illnesses or take certain medications that weaken bones.

Symptoms

Common symptoms

• Low bone density usually has no symptoms until you break a bone.
• Some people notice a gradual loss of height or a stooped posture as the spine weakens.
• A sudden, severe back pain may be a sign of a spinal fracture.

Symptoms in children

• Bone density testing is rarely needed for children, but if it is done, there are usually no symptoms.
• In children, low bone density may be linked to a chronic illness or medicine, not to ordinary bone weakness.

Symptoms in older adults

• Older adults may have no warning signs until a bone breaks.
• Wrist, hip, or spine fractures after a minor fall can be the first clue.
• Loss of height or a curved upper back can mean the spine has weakened.

Causes

Main causes

• Aging: Bones naturally become thinner and less dense as we get older.
• Hormone changes: Low estrogen in women after menopause and low testosterone in men can speed up bone loss.
• Calcium and vitamin D deficiency: Your bones need these nutrients to stay strong.
• Physical inactivity: Lack of weight-bearing exercise can cause bones to weaken.
• Certain medical conditions and medicines: Long-term steroid use, some digestive diseases, and overactive thyroid can all affect bones.

Risk factors

• Being older than 50
• Being female, especially after menopause
• Having a family history of osteoporosis or broken bones
• Being underweight or having a very low body mass index
• Smoking or drinking too much alcohol
• A diet low in calcium and vitamin D
• Not doing enough weight-bearing exercise
• Taking certain medicines for a long time, such as steroids for asthma or arthritis

When to see a doctor

See a doctor urgently if:

• You have a sudden, severe back pain or hip pain after a minor fall or even without any fall.
• You have a broken bone after a simple trip or bump.
• You have lost more than 2 inches (5 cm) of height in less than a year.

Book a routine appointment if:

• You are a woman age 65 or older, or a man age 70 or older, and you have never had a bone density test.
• You are past menopause and have risk factors such as smoking, low body weight, or a family history of osteoporosis.
• You take medicine that weakens bones, like steroids, for a long time.
• You have a health condition that affects how your body absorbs nutrients.

Diagnosis

A bone density test is the main way to diagnose low bone density and osteoporosis. It checks the strength of your bones and gives you a number called a T-score. This number compares your bone density to that of a healthy young adult of the same sex.

Tests that may be done

• DEXA scan: The most common and accurate test, using a low-dose X-ray to measure bone density in the hip and spine.
• Peripheral DEXA: A smaller portable machine that checks bones in the wrist, heel, or finger, often used as a screening tool.
• FRAX score: This is not a scan but a computer questionnaire that uses your bone density result plus your age, weight, and risk factors to estimate your chance of a fracture in the next 10 years.

What to expect at your appointment

You will lie on a padded table, fully clothed. The scanner will move over your body, and you just need to stay still. It feels like an X-ray and is not painful. You can go back to your normal day right after. Your doctor will usually get the results within a few days and explain what your T-score means.

Treatment

If your bone density is lower than normal, the goal is to prevent fractures. Treatment may include lifestyle changes, extra calcium and vitamin D, and sometimes medication. Your doctor will tailor the plan to your age, your bone density score, and your personal risk of breaking a bone.

Self-care at home

• Make sure you get enough calcium and vitamin D from food or supplements, as your doctor advises.
• Do weight-bearing exercise like walking, dancing, or climbing stairs most days of the week.
• Do balance exercises like tai chi or yoga to help prevent falls.
• Stop smoking and limit alcohol.
• Make your home safer by removing loose rugs, adding grab bars in the bathroom, and improving lighting.

Medical treatments

There are several types of medication that can help slow bone loss or build new bone. These are usually pills taken once a week, or sometimes injections given a few times a year. Your doctor will prescribe the one that is right for you, and you will need regular check-ups to monitor how well it works. Your doctor can also talk to you about calcium and vitamin D supplements if you are not getting enough from food.

When is surgery considered?

Surgery is not used to treat low bone density itself. However, if you break a bone, especially a hip or spine, surgery may be needed to repair it. For some spinal fractures caused by weak bones, a procedure called vertebroplasty or kyphoplasty may be an option, but your doctor will explain the benefits and risks.

Living with this condition

Living with low bone density means being mindful of your bones every day. You can stay active, eat well, and avoid risky activities that could lead to falls. Small changes like wearing supportive shoes, using a walking stick if needed, and keeping your home clutter-free can make a big difference.

Lifestyle tips

• Stay active with exercises that are safe for your bones, like walking or gentle strength training.
• Do balance work every day, such as standing on one foot or practicing heel-to-toe walking.
• Get help with heavy lifting or reaching for items on high shelves.
• Have your vision and hearing checked regularly to reduce fall risk.
• Talk to your doctor about medicines that may make you dizzy, as they can increase fall risk.

Diet and exercise

Eat a balanced diet rich in calcium and vitamin D. Good sources include dairy products, leafy green vegetables, fortified cereals, and oily fish. If you cannot get enough from food, ask your doctor about supplements. For exercise, combine weight-bearing activities like brisk walking or jogging with strength training exercises using light weights or resistance bands. Aim for at least 150 minutes of moderate activity each week, but check with your doctor first.

Mental health and emotional wellbeing

Learning that you have low bone density can feel worrying, but it is a manageable condition. Some people feel anxious about falling or breaking a bone. It is important to remember that with the right treatment and lifestyle, you can lower your risk and stay active. If you feel down, talk to your doctor or a counsellor.

Prevention

You can help prevent low bone density and osteoporosis by building strong bones early in life and keeping them strong as you age. This means getting enough calcium and vitamin D, staying physically active, not smoking, limiting alcohol, and avoiding falls. Even if you already have low bone density, these steps can slow down further bone loss.

Vaccines

There are no vaccines for osteoporosis, but staying up to date on recommended vaccines, like the flu and pneumonia vaccines, can help you avoid illnesses that may make you weak or more likely to fall.

Screening programmes

Screening for low bone density is recommended for certain people based on age and risk factors. Women are usually screened at age 65, and men at age 70, or earlier if they have risk factors. Your doctor can tell you when to start and how often to repeat the test.

Complications

If left untreated

• A broken bone from a minor fall, especially in the hip, wrist, or spine.
• Spinal fractures that cause height loss, a curved back, and chronic pain.
• Loss of mobility and independence after a hip fracture.
• Increased risk of another fracture once you have had one.

Long-term outlook

There is good news: even if you already have low bone density, you can still do a lot to protect your bones. With the right lifestyle, nutrition, and medical care, many people avoid fractures and stay active well into old age. It is never too late to take positive steps for your bone health.

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