Osteoporosis has no obvious symptoms in its early stages. Most people don’t know they have it until they break a bone from something minor, like a fall from standing height, or until a bone density scan reveals the loss. That’s why understanding your risk factors and knowing when to get tested matters more than watching for symptoms.
Why Osteoporosis Is Called a “Silent” Disease
Bone loss happens gradually over years without causing pain or any sensation you’d notice. Unlike conditions that announce themselves with clear warning signs, osteoporosis quietly weakens your skeleton from the inside. The internal structure of bone becomes porous and thin long before anything feels different on the outside.
By the time physical signs do appear, significant bone loss has already occurred. This is why screening and risk awareness are the primary ways osteoporosis gets caught, not symptom recognition.
Physical Signs That May Point to Bone Loss
When osteoporosis does produce visible changes, they’re usually the result of vertebral compression fractures, where weakened bones in the spine partially collapse under the body’s own weight. These fractures can happen without a dramatic injury and sometimes without severe pain, so they often go undiagnosed.
The signs of a compression fracture include sudden back pain that worsens with movement and improves with rest, difficulty bending or twisting, muscle spasms near the fracture site, and tingling or numbness if the fracture pinches a nerve. Over time, multiple compression fractures cause a noticeable loss of height and a forward-curving posture (sometimes called a dowager’s hump). If you’ve lost height or notice your upper back rounding forward, that’s worth bringing up with your doctor.
A fracture from minimal force is one of the strongest indicators of osteoporosis. The World Health Organization defines a fragility fracture as one caused by low-energy trauma, like falling from standing height or less. Breaking a bone from a minor stumble, a hard cough, or simply bending over is not normal at any age and should prompt a bone density evaluation.
Who Should Get Screened
The U.S. Preventive Services Task Force recommends routine bone density screening for all women 65 and older. Postmenopausal women younger than 65 should also be screened if they have one or more risk factors for osteoporosis. For men, there isn’t yet enough evidence to make a blanket screening recommendation, but doctors typically order testing for men with specific risk factors or a history of fragility fractures.
Key risk factors that should prompt earlier screening or a conversation with your doctor include:
- Family history of osteoporosis or hip fracture in a parent
- Low body weight or a small frame
- Smoking or heavy alcohol use
- Early menopause (before age 45) or low estrogen levels
- Long-term use of certain medications (more on this below)
- Conditions that affect nutrient absorption, such as celiac disease or inflammatory bowel disease
- A previous fracture from minor trauma
Medications That Weaken Bones
Several common medications accelerate bone loss, and if you take any of them long-term, you may need earlier screening. Corticosteroids like prednisone are the most well-known culprits. Taking 5 mg or more daily for three months or longer suppresses the cells that build bone while activating the cells that break it down.
Proton pump inhibitors, the drugs used for chronic heartburn, have been linked to increased hip fracture risk in older adults when used at high doses for several years, likely because they reduce calcium absorption. Hormone-blocking cancer treatments also carry significant risk: androgen deprivation therapy for prostate cancer causes the greatest bone density drop in the first year, and aromatase inhibitors used in breast cancer treatment block estrogen production and increase fracture risk at the spine and wrist.
Other medications associated with bone loss include certain anti-seizure drugs, some type 2 diabetes medications, loop diuretics (which cause the kidneys to excrete more calcium), and the injectable contraceptive Depo-Provera with long-term use. If you’ve been on any of these for an extended period, it’s reasonable to ask whether bone density testing makes sense for you.
How Bone Density Testing Works
The standard test for osteoporosis is a DXA scan (sometimes written DEXA), which stands for dual-energy X-ray absorptiometry. It’s a painless, noninvasive scan that takes about 10 to 15 minutes. You lie on a padded table while a low-dose X-ray arm passes over your body. The radiation exposure is extremely small, less than what you’d get from a chest X-ray.
The scan measures bone mineral density at the sites most vulnerable to osteoporotic fractures: the lower spine (lumbar vertebrae), the narrow neck of the thighbone near the hip joint, and sometimes the forearm. These locations give the most reliable picture of fracture risk. Heel scanners exist at some pharmacies and health fairs, but a heel measurement isn’t as accurate a predictor of fracture risk as a spine or hip measurement.
Understanding Your T-Score
Your DXA results come back as a number called a T-score, which compares your bone density to that of a healthy 30-year-old adult at peak bone mass. The National Institute of Arthritis and Musculoskeletal and Skin Diseases defines the ranges this way:
- T-score of -1.0 or higher: normal, healthy bone density
- T-score between -1.0 and -2.5: osteopenia, a milder form of bone density loss that may or may not progress to osteoporosis
- T-score of -2.5 or lower: osteoporosis
A T-score alone doesn’t tell the whole story, though. Your doctor may also use a tool called FRAX, which estimates your 10-year probability of a major fracture based on your T-score combined with clinical risk factors like age, body weight, smoking status, family history, and medication use. Age is particularly important because fracture risk rises with age independent of bone density. Two people with the same T-score can have very different fracture risks depending on their age and other factors.
Blood Tests and Other Evaluations
A DXA scan tells you how dense your bones are right now, but it doesn’t explain why you might be losing bone. Your doctor may order blood or urine tests to look for underlying causes or to measure how fast bone is being broken down and rebuilt.
Common blood work includes vitamin D levels, calcium, thyroid function, and sometimes markers of bone turnover. Bone formation markers measure how actively your body is building new bone, while resorption markers reflect how quickly old bone is being broken down. These results can help guide treatment decisions and provide a baseline for tracking whether treatment is working over time.
Your doctor may also check for secondary causes of bone loss, such as overactive thyroid or parathyroid glands, kidney disease, or conditions that impair nutrient absorption. Treating an underlying cause can sometimes slow or stop further bone loss on its own.
What to Do if You’re Concerned
If you’re a woman over 65, getting a DXA scan is straightforward since it’s a recommended screening. If you’re younger but postmenopausal with risk factors, or if you’ve broken a bone from a minor fall, ask your doctor about scheduling one. For men, the conversation typically starts with risk factors or a fracture history rather than age alone.
Before your appointment, it helps to know your family history of fractures (especially a parent’s hip fracture), have a list of your current medications, and note whether you’ve lost height or experienced unexplained back pain. These details help your doctor decide which tests to order and how urgently. Osteoporosis is highly treatable when caught early, but it has to be found first.