Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women Osteoporotic fracture risk assessment Screening for osteoporosis in postmenopausal women and men.

htm , available in Spanish. org , available in English and Spanish. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in.

Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Bone density testing Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic.

Find in topic Formulary Print Share. Outline SUMMARY WHAT DOES BONE DENSITY TESTING DO AND WHY IS IT IMPORTANT? Risk factors for fracture WHICH TEST IS BEST?

Dual-energy x-ray absorptiometry Quantitative computerized tomography Ultrasound WHAT TO EXPECT FROM A DXA TEST WHAT DO THE RESULTS MEAN? Normal bone density Low bone mass osteopenia Osteoporosis Fracture prediction tool DO I NEED TO HAVE BONE DENSITY TESTING AGAIN?

Authors: Joel S Finkelstein, MD Elaine W Yu, MD Section Editor: Clifford J Rosen, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Sep 29, There are several different types of bone density tests.

WHAT TO EXPECT FROM A DXA TEST During dual-energy x-ray absorptiometry DXA , you lie on an examination table. SUMMARY Bone density tests help health care providers spot bone loss in people who might otherwise have no symptoms. Patient education: Bone density testing The Basics Patient education: Osteoporosis The Basics Patient education: Calcium and vitamin D for bone health The Basics Patient education: Vitamin D deficiency The Basics Patient education: Primary hyperparathyroidism The Basics Patient education: Hip fracture The Basics Patient education: Vertebral compression fracture The Basics Patient education: Cadmium toxicity The Basics Patient education: Medicines for osteoporosis The Basics Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

Patient education: Osteoporosis prevention and treatment Beyond the Basics Patient education: Calcium and vitamin D for bone health Beyond the Basics Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women Osteoporotic fracture risk assessment Screening for osteoporosis in postmenopausal women and men The following organizations also provide reliable health information.

org , available in English and Spanish [ ]. Incidence and economic burden of osteoporosis-related fractures in the United States, J Bone Miner Res ; Binkley N, Bilezikian JP, Kendler DL, et al.

Summary of the International Society For Clinical Densitometry Position Development Conference. Hodgson SF, Watts NB, Bilezikian JP, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: edition, with selected updates for Endocr Pract ; Raisz LG.

Clinical practice. Screening for osteoporosis. N Engl J Med ; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient.

It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications.

This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof.

All rights reserved. Topic Feedback. Definitions of normal bone density, osteopenia, and osteoporosis. Osteoporosis can affect anyone at any age, although older postmenopausal women are particularly at risk. This is because the level of oestrogen declines after the menopause , resulting in a decrease in bone density.

The more dense your bones, the stronger and less likely they are to break fracture. Osteoporosis does not cause any symptoms until a bone is broken. Find out when bone density scans are used. During a bone density scan, a type of X-ray called dual energy X-ray absorptiometry is passed through your body.

This is shortened to DEXA. Some radiation is absorbed by the bone and soft tissue, and some travels through your body. Special detectors in the DEXA machine measure how much radiation passes through your bones, and this information is sent to a computer.

A bone density test is one way to check the health of your bones. It measures how many grams of calcium and other bone minerals are in a segment of your bone. The higher the bone mineral content, the denser the bones are. The denser the bones are, the stronger they generally are and the less likely they are to break.

Depending on your level of osteoporosis risk, it could be as soon as age Bart Clarke , Endocrinology, Mayo Clinic, Rochester, Minn.

You may be familiar with high-density, or good cholesterol; low-density lipoproteins LDL , or bad cholesterol; and their connections to heart health. But what about triglycerides? Often thatRead more. Lisa Brown, 53, of Jacksonville, suffered from severe pelvis and back pain for years.

She later learned that her bladder wasn't working due to follicularRead more. They have a new baby girl, and Dad got the lifesaving heartRead more. By Liza Torborg. Share this:. Mayo Clinic Minute: What high triglycerides mean and why it matters to your heart.

First-line pharmacologic options determined by the FDA to be safe and effective for osteoporosis prevention bisphosphonates [alendronate and risedronate], raloxifene, and estrogen should be used. First-line pharmacologic options determined by the FDA to be safe and effective for osteoporosis treatment bisphosphonates [alendronate and risedronate], raloxifene, calcitonin, and parathyroid hormone should be used.

The following recommendations are based on limited or inconsistent scientific evidence Level B :. Bone mineral density testing should be recommended to all postmenopausal women who are 65 years of age or older. Bone mineral density testing should be recommended for postmenopausal women younger than 65 years of age who have one or more risk factors for osteoporosis.

Bone mineral density testing should be performed on all postmenopausal women who have fractures to confirm the diagnosis of osteoporosis and determine disease severity. In the absence of new risk factors, screening should not be performed more frequently than every two years.

The following recommendation is based primarily on consensus and expert opinion Level C :. Women should be counseled on the risk of osteoporosis and related fragility fractures. Such counseling should be part of the annual gynecologic examination. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

search close. PREV Mar 15, NEXT. Clinical Considerations and Recommendations. Summary of ACOG Recommendations. Women should be counseled about the following preventive measures: Adequate calcium consumption, using dietary supplements if dietary sources are not adequate Adequate vitamin D consumption to IU daily and the natural sources of this nutrient Regular weight-bearing and muscle-strengthening exercise to reduce falls and prevent fractures Smoking cessation Moderation of alcohol intake Fall-prevention strategies Bone mineral density testing should be recommended to all postmenopausal women who are 65 years of age or older.

This series is coordinated by Michael J. Arnold, MD, associate medical editor. Continue Reading. Can Med Assoc J. Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP.

Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

search close. PREV Oct 15, NEXT. The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.

The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.

The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.

The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits. The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service].

Evidence that [the service] is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Summary of Recommendations.

Good: Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes. Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies; generalizability to routine practice; or indirect nature of the evidence on health outcomes.

Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.

Clinical Considerations. Preventive Services Task Force recommendations are independent of the U. They do not represent the views of the Agency for Healthcare Research and Quality, the U. Department of Health and Human Services, or the U.

Subsequent testing varies according to your individual situation. For postmenopausal women and men age 50 years and older, the T-score is the number that is used for diagnostic classification, as follows:.

It is important to recognize that you may be diagnosed with osteoporosis when the T-score is better than Also, when the T-score is or below, you could have disease other than osteoporosis, such as osteomalacia or multiple myeloma. Your healthcare provider can evaluate you to be sure the diagnosis is correct or refer you to someone who can.

The results of your bone density test, combined with all available clinical information, including your personal preference and previous experience with medications, can help with deciding to start, continue, or change medication to make your bones stronger and reduce the risk of breaking bones.

Medications have been tested and approved for prevention and for treatment of osteoporosis. Each of these medications has its pros and cons.

If you need take a medication, any one of them may be better than none, but some are better than others for increasing bone density and reducing the risk of breaking bones. Talk with your healthcare provider to find out which is best for you.

If you decide not to take a medication, it is often a good idea to monitor your bone density and reconsider your treatment decisions from time to time.

Regardless of whether you take a prescription medication, remember the essentials for good bone health: regular weight-bearing and muscle strengthening physical activity, maintaining good balance, avoiding falls, adequate intake of calcium and vitamin D, not smoking, avoiding excessive alcohol intake, and when possible, avoiding or minimizing exposure to drugs that are harmful to bones, such as prednisone.

Join our community to learn more about osteoporosis, or connect with others near you who are suffering from the disease.

Membership in BHOF will help build your practice, keep your team informed, provide CME credits, and allow you access to key osteoporosis experts. Bone Density Testing Are you a woman age 65 years or older, a man age 70 years or older, or have you broken a bone had a fracture since age 50 years?

What Is a Bone Density Test? DXA is a non-invasive test to measure bone density. Pulse-echo ultrasound P-EU — uses no radiation and measures the thickness of cortical bone at peripheral skeletal sites with a handheld device.

Studies have shown a significant correlation between measurements from P-EU and bone mineral density measured by DXA at the hip. Stay Connected Join our community to learn more about osteoporosis, or connect with others near you who are suffering from the disease. Sign Up Now Support BHOF Join us in the fight against osteoporosis.