How do I know whether my bones are strong enough (osteoporosis)?
Have your bone density measured with a DXA scan if you have risk factors, because osteoporosis produces no symptoms of its own until a fracture occurs. Once the diagnosis has been established, there are effective medications that demonstrably reduce fracture risk.
The most reliable way to measure bone strength is a DXA scan: a painless, quick scan that uses a low radiation dose. The result is expressed as a T-score. If that score is -2.5 or lower, you have osteoporosis. A score between -1 and -2.5 is called osteopenia: lower bone density, but not yet osteoporosis.
Osteoporosis produces no symptoms for a long time. Many people only notice it when a bone breaks after a minor fall or a light knock, a so-called 'fragility fracture'. Early warning signs include sudden back pain from a vertebral fracture, or pain in the groin or thigh from a hip fracture. If you have risk factors, do not wait for symptoms -- discuss a scan with your GP.
In addition to the DXA scan, there is the FRAX tool. This is a calculation aid that uses your age, sex, weight and other factors to estimate your probability of a fracture in the next ten years. In cases of high FRAX risk, or if you have already had a fragility fracture, the diagnosis can be made without a DXA scan.
Certain conditions substantially increase the risk: low testosterone or oestrogen levels (such as during the menopause), prolonged use of corticosteroid medications, excessive alcohol consumption and thyroid problems. Up to half of all cases in men have such an underlying cause. Men are greatly underestimated: around 40% of all osteoporotic fractures affect men, yet only 10% receive adequate treatment. Their mortality rate after a first fracture is even higher than in women1,2,3,4,5,6,7,8.
If osteoporosis has been diagnosed, there are effective medications that reduce fracture risk, such as bisphosphonates, denosumab and teriparatide. Which medication is appropriate depends on your individual situation. Some have rare but serious side effects, such as atypical femoral fractures. Always discuss the duration of treatment with your doctor. Adequate calcium and vitamin D, exercise, not smoking and moderate alcohol intake support your bones, but in the case of confirmed osteoporosis they do not replace medication.
The claims are based on multiple guidelines and reviews (PMIDs: 39448132, 34688418, 36382763, 33017332, 21450337, 9431639, 41252575, 34023036). The diagnostic value of the DXA scan and the T-score are strongly supported. Lifestyle recommendations are moderately supported: no large randomised studies are present in the sources provided.