How do I know whether my bones are strong enough (osteoporosis)?
With a DXA scan and, if needed, a FRAX risk calculation, you can have your GP check whether your bones are strong enough -- especially if you have risk factors or have already broken a bone from a minor fall.
The most reliable way to find out whether your bones are strong enough is a bone density scan, also known as a DXA scan. This measurement gives you a T-score. A score of -2.5 or lower confirms osteoporosis. DXA is considered the gold standard and forms the basis of every diagnosis.
Have you ever broken a bone from a minor force, such as a fall from standing height? If so, osteoporosis can also be diagnosed without reaching that threshold. Such a 'fragility fracture' is itself already a warning sign, even if your T-score has not yet reached -2.5.
In addition to the scan, doctors often use a FRAX score: a calculation that estimates your risk of a bone fracture over the next 10 years. It takes multiple factors into account, such as age, sex, weight, and any previous fractures. If the risk is high, treatment may be recommended even before the threshold has been reached.
Osteoporosis causes no symptoms for a long time. The first sign is often a sudden, severe back pain caused by a collapsing vertebra, or pain in the groin or upper thigh due to a hip fracture. Because you cannot feel it yourself, active screening is worthwhile. Have you been taking prednisone for a long time, do you regularly drink too much alcohol, or do you have a thyroid or hormonal problem? Then your risk is even higher -- especially if you are a man: osteoporosis is often seen as a women's disease, but around 40% of all osteoporotic fractures affect men, in whom the consequences are on average even more serious.
A complete picture is obtained through a combination of a consultation about your symptoms and risk factors, a physical examination, blood tests to rule out other causes, a DXA scan, and possibly X-rays of the spine. If you have concerns about your bone health, discuss them with your GP.
All claims are based on diagnostic guidelines and clinical studies (PMIDs 39448132, 34688418, 36382763, 9431639, 33017332, 21450337). DXA as the gold standard and the T-score threshold of -2.5 are robustly supported.
How do I keep my bones strong after menopause?
You can protect your bones well after menopause with lifestyle measures and, depending on your risk, with medication. If you have risk factors, get a bone density scan done and discuss the options with your doctor.
Stronger bones and strength training -- does it help?
Strength training measurably improves bone density, although the effect remains modest. For the strongest results, high-intensity training under supervision is recommended, even if you already have low bone mass.
Do you really need calcium supplements for strong bones?
Whether you need calcium supplements depends strongly on your age and circumstances: for young, healthy women there is no evidence of benefit, while people over 50 may benefit from calcium plus vitamin D, provided the increased risk of kidney stones is taken into account.
How do I know if I am at risk of osteoporosis?
You can get a good sense of your risk based on age, sex, hormonal history, medication use and lifestyle. If you have multiple risk factors, ask your general practitioner for a bone density measurement.
Does vitamin D prevent me from breaking bones?
Vitamin D alone does not demonstrably reduce the risk of bone fractures. Combined with calcium it does help, especially in older adults and people with a deficiency.
How do I know whether I have enough vitamin D, and should I be supplementing?
A blood test (25-OHD) tells you whether you have a deficiency; if your value is below 20 ng/mL, supplementing is worthwhile, especially for your bones. Vitamin D has no proven effect on your heart.