osteoporosis screening test preparation

Overview

Osteoporosis is a condition where bones become weak, thin, and more likely to break. A bone density test (also called a DEXA scan) is a quick, painless screening to check your bone health and see if you have osteoporosis or are at risk.

Yes, osteoporosis is very common, especially in older adults. It is often called a 'silent disease' because you don't feel bone loss until a fracture happens.

It mainly affects women after menopause, but men and younger people with certain conditions can also develop it.

Symptoms

Common symptoms

• Osteoporosis usually has no symptoms in early stages. Later, symptoms may include back pain from a fractured or collapsed vertebra, loss of height over time, a stooped posture, or a bone that breaks much more easily than expected.

Symptoms in children

• Osteoporosis in children is rare. When it occurs, it may be due to an underlying medical condition or medication. Symptoms can include bone pain, difficulty walking, or fractures from minor injuries.

Symptoms in older adults

• In older adults, symptoms can include back pain, a curved spine (dowager's hump), and fractures from simple actions like bending over or coughing.

Causes

Main causes

• Bone loss occurs when the body breaks down old bone faster than it can make new bone. As we age, bone density naturally decreases.
• Hormonal changes, especially lower estrogen in women after menopause, accelerate bone loss.
• Certain medical conditions and long-term use of some medications can also cause bone thinning.

Risk factors

• Age over 50
• Being female, especially after menopause
• Family history of osteoporosis or hip fracture
• Low body weight or small frame
• Smoking or excessive alcohol intake
• Lack of calcium and vitamin D
• Prolonged use of corticosteroid medications (like prednisone)
• Certain conditions like rheumatoid arthritis, thyroid disorders, or malabsorption issues

When to see a doctor

See a doctor urgently if:

• You have a bone fracture from a minor bump or fall.

Book a routine appointment if:

• You are a woman age 65 or older – screening is recommended.
• You are a man age 70 or older.
• You have risk factors like early menopause, low body weight, or long-term steroid use.
• You have had a fracture after age 50.

Diagnosis

Osteoporosis is diagnosed with a bone density test, most commonly a DEXA (dual-energy X-ray absorptiometry) scan. This test measures how strong and thick your bones are. Results are given as a T-score: -1.0 or above is normal, between -1.0 and -2.5 indicates osteopenia (low bone mass), and -2.5 or below indicates osteoporosis.

Tests that may be done

• Bone density test (DEXA scan)
• Sometimes a blood test to check for other conditions that cause bone loss
• A fracture risk assessment (FRAX tool) that combines your bone density with other risk factors

What to expect at your appointment

For a DEXA scan, you lie on a padded table while a scanner passes over your body. It is painless and takes about 10–20 minutes. You do not need to undress, but avoid wearing clothes with metal (zippers, buttons). Do not take calcium supplements for 24 hours before the test because calcium can affect the measurement. You can eat and drink normally before the test. After the scan, your doctor will review the results and discuss what they mean for your bone health.

Treatment

Treatment for osteoporosis focuses on slowing bone loss and building new bone to reduce the risk of fractures. Your doctor will tailor a plan based on your age, sex, bone density, and overall health.

Self-care at home

• Get enough calcium and vitamin D through diet or supplements (ask your doctor for the right amount for you)
• Do weight-bearing exercises like walking, dancing, or stair climbing
• Do muscle-strengthening exercises like lifting light weights or using resistance bands
• Avoid smoking and limit alcohol to less than 2 drinks per day
• Take steps to prevent falls, such as removing tripping hazards at home and wearing supportive shoes

Medical treatments

Medications for osteoporosis work in different ways – some slow bone loss, others help build bone. Common types include bisphosphonates (taken by mouth or injection), hormone-related therapy, and newer injectable drugs that stimulate bone formation. Your doctor will discuss which option is best for you based on your health history and bone density results. You may also be prescribed calcium and vitamin D supplements if your diet is insufficient.

When is surgery considered?

Surgery is rarely needed for osteoporosis itself, but if you have a hip fracture, surgery may be required to repair or replace the hip. Vertebral fractures (crushed spinal bones) may be treated with a procedure called vertebroplasty or kyphoplasty, where bone cement is injected to stabilize the bone. But most fractures are managed with medication, rest, and physical therapy.

Living with this condition

Living with osteoporosis means being mindful of your bones. You can still lead an active life, but you need to avoid high-impact activities that could cause fractures. Focus on balance exercises to prevent falls. Use safety devices like grab bars in the bathroom. Wear sturdy shoes. Tell your dentist you have osteoporosis before any dental work, as some medications affect healing.

Lifestyle tips

• Eat a bone-healthy diet rich in calcium (dairy, leafy greens, fortified foods) and vitamin D (fatty fish, egg yolks, fortified milk, sunlight)
• Stay active with low-impact exercises like swimming, tai chi, or yoga (avoid poses that involve bending forward or twisting the spine)
• Maintain a healthy body weight – being underweight increases fracture risk
• Get enough sleep and manage stress

Diet and exercise

A diet high in calcium and vitamin D is key. Aim for 3 servings of dairy daily, or calcium-fortified alternatives. Include protein from lean meats, beans, or tofu. Exercise should focus on weight-bearing (walking, jogging) and resistance training. Avoid excessive alcohol and caffeine, which can worsen bone loss.

Mental health and emotional wellbeing

Osteoporosis can cause fear of falling or breaking a bone, which may lead to anxiety, depression, or social withdrawal. It's normal to feel worried. Talk to your healthcare team about your concerns. Joining a support group can help. Consider counseling if you feel anxious or down most days.

Prevention

You can reduce your risk of developing osteoporosis by building strong bones early in life and maintaining bone health as you age. Getting enough calcium and vitamin D, staying physically active, not smoking, and limiting alcohol can all help. For people at high risk, screening and early treatment can prevent fractures.

Vaccines

Some vaccines (like the flu or pneumonia vaccine) are not directly related to osteoporosis, but staying up to date with vaccines helps prevent infections that could lead to falls or other complications. Ask your doctor.

Screening programmes

Screening for osteoporosis is done with a bone density test (DEXA scan). It is recommended for women age 65 and older, and men age 70 and older. Younger adults with risk factors should also be screened. Talk to your healthcare provider about when you should have a scan. To prepare: do not take calcium supplements for 24 hours before the test, and wear comfortable clothes without metal.

Complications

If left untreated

• Fractures of the hip, spine, wrist, or other bones from simple falls or even everyday activities
• Chronic pain and disability from vertebral fractures
• Loss of height and a stooped posture (dowager's hump)
• Difficulty getting around and loss of independence

Long-term outlook

With early detection and proper management, many people with osteoporosis can lead full, active lives and reduce their fracture risk significantly. Treatments today are very effective. Even if you have already had a fracture, you can still take steps to strengthen your bones and prevent future breaks. It is never too late to care for your bone health.

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