You cannot know for certain without a bone density test

Osteoporosis has no symptoms you can feel. You will not know you have it from pain, weakness, or how you move — many people discover it only after a fracture, or during a routine screening. The only way to know your actual bone density is a DEXA scan (dual-energy X-ray absorptiometry), which takes pictures of your bones and measures how dense they are. Your doctor orders this test; you cannot order it yourself.

A DEXA scan takes about 10 to 30 minutes, involves no needles, and uses a very small amount of radiation — less than a chest X-ray. You lie still on a table while a scanner passes over your hip, spine, and sometimes your forearm. The results come back as a T-score, which compares your bone density to that of a healthy 30-year-old. A T-score of −1.0 or higher is normal. A score between −1.0 and −2.5 means low bone density (sometimes called osteopenia). A score below −2.5 means osteoporosis.

Key Takeaways

  • A DEXA scan is the only way to know whether you have osteoporosis; symptoms do not appear until a fracture happens.
  • Your doctor decides whether you need screening based on your age, sex, medical history, and risk factors — not on how you feel.
  • A broken bone from a minor fall or bump can be the first sign of osteoporosis, especially in the hip, spine, or wrist.
  • If your DEXA results show low bone density, your doctor will discuss whether treatment and lifestyle changes are right for you.
  • Screening guidelines differ for men and women, and your doctor may recommend testing earlier if you have certain risk factors.

Who should get screened and when

The U.S. Preventive Services Task Force recommends bone density screening for all women age 65 and older, and for postmenopausal women under 65 who have risk factors. For men, the recommendation is less uniform — some guidelines suggest screening at age 70, others recommend it only for men with specific risk factors. Your doctor is the one who decides whether you need a DEXA scan, based on your personal history.

Risk factors that may move your screening earlier include a family history of osteoporosis or hip fracture, current smoking, heavy alcohol use, long-term use of certain medications (like corticosteroids), rheumatoid arthritis, or a previous fracture as an adult. If you have had a fracture from a fall from standing height or less, your doctor may order a DEXA scan to check your bone density, even if you are younger than the standard screening age.

If you have already had one DEXA scan, your doctor will decide how often you need another. For many people with normal bone density, rescreening happens every 10 years. If you have low bone density or osteoporosis, you may be rescanned every 1 to 2 years to see whether treatment is working.

Signs that might prompt your doctor to order a test

Even if you have no symptoms, certain situations make a DEXA scan more likely. A fracture from a minor fall — tripping on a step, bumping into furniture, or falling from standing height — is a red flag. The hip, spine, and wrist are the most common fracture sites in osteoporosis, but a break anywhere from a small accident suggests weaker bones. Your doctor will order imaging to confirm the fracture and may follow up with a DEXA scan.

Height loss is another clue. If you have lost more than an inch or two over time, or if someone close to you has noticed you are stooped or bent forward, vertebral fractures (breaks in the spine) may have happened without you feeling them. These fractures can cause gradual height loss and a curved upper back. Your doctor can ask about this during a routine visit and order a DEXA scan if it seems likely.

Certain medical conditions and medications also raise the likelihood of testing. Long-term use of corticosteroids (like prednisone for asthma or autoimmune disease), some cancer treatments, and conditions that affect how your body absorbs calcium — such as celiac disease or inflammatory bowel disease — all increase fracture risk. If you take these medications or have these conditions, your doctor may recommend screening even if you have no other symptoms.

What your DEXA results mean

Your DEXA report will show your T-score and sometimes a Z-score. The T-score is what matters most for diagnosis. A T-score of −2.5 or lower means osteoporosis. A score between −1.0 and −2.5 means low bone density. Above −1.0 is considered normal for your age.

The Z-score compares your bone density to others your age and sex. It is less commonly used for diagnosis but can help your doctor understand whether your bone loss is typical for your age or faster than expected. If your Z-score is unusually low, your doctor may look for other causes of bone loss, such as a thyroid problem or vitamin D deficiency.

Your doctor will explain what your score means for your individual situation. A T-score in the osteoporosis range does not automatically mean you will have a fracture — it means your risk is higher. Your doctor will consider your age, sex, other health conditions, and family history when deciding whether to recommend treatment.

What happens after a diagnosis

If your DEXA results show osteoporosis or low bone density, your doctor will discuss next steps with you. This may include blood tests to check your vitamin D level, calcium intake, and thyroid function. Your doctor will also ask about your diet, exercise, smoking, and alcohol use — all of which affect bone health.

Treatment is not automatic. For some people, especially those with low bone density but no fracture history, the first step is lifestyle change: more weight-bearing exercise, adequate calcium and vitamin D, and stopping smoking or cutting back on alcohol. For others, particularly those with osteoporosis or a history of fracture, medication may be recommended. Common medications include bisphosphonates (like alendronate), which slow bone loss.

Your doctor will also talk about fall prevention. Osteoporosis itself causes no pain or weakness, but a fall can cause a serious fracture. straightforward steps like removing tripping hazards at home, wearing proper shoes, checking your vision, and reviewing medications that might make you dizzy can reduce your fracture risk significantly.

The difference between osteoporosis and osteopenia

Low bone density (osteopenia) and osteoporosis are not the same diagnosis, though they are related. Osteopenia means your bones are weaker than normal but not yet weak enough to be called osteoporosis. Not everyone with osteopenia will develop osteoporosis, and not everyone with osteopenia will have a fracture.

If you have osteopenia, your doctor will likely recommend lifestyle measures: weight-bearing exercise, adequate calcium and vitamin D, and fall prevention. Medication is usually not the first step unless you have other risk factors, such as a previous fracture or a family history of hip fracture. Your doctor may recommend rescreening in a few years to see whether your bone density is stable, improving, or declining.

Why you might not feel anything even with weak bones

Bone is living tissue that constantly breaks down and rebuilds. When you have osteoporosis, the rebuilding does not keep up with the breakdown, so bones become less dense over time. This happens silently — there are no nerve endings in bone that signal weakness or thinning. You feel fine until a fracture occurs.

This is why screening is important, especially as you age. A DEXA scan can catch bone loss before a fracture happens, giving you and your doctor time to slow or stop the loss through exercise, nutrition, and sometimes medication. A fracture, by contrast, is painful and can cause lasting disability. Finding osteoporosis early through screening is far better than discovering it after a break.

Frequently Asked Questions

Can I have osteoporosis without knowing it?

Yes. Osteoporosis causes no pain, weakness, or other symptoms until a fracture occurs. Many people have it for years without knowing, which is why screening is recommended for older adults and those with risk factors. A DEXA scan is the only way to know your bone density.

What should I do if I think I might have osteoporosis?

Talk to your doctor. Tell them about any fractures you have had, family history of osteoporosis, your medications, and your lifestyle. Your doctor will decide whether a DEXA scan is right for you based on your age, sex, and risk factors. Do not wait for symptoms — there are none.

How much does a DEXA scan cost?

Cost varies by location and insurance. Medicare covers DEXA scans for women age 65 and older and for certain younger women and men with risk factors. Many private insurance plans cover screening as well. Ask your doctor's office or your insurance company what you would pay out of pocket.

If I have low bone density, will I definitely get osteoporosis?

Not necessarily. Low bone density (osteopenia) means your bones are weaker than average, but many people with osteopenia never develop osteoporosis or have a fracture. Your doctor will recommend lifestyle changes and may suggest rescreening in a few years to track whether your bone density is stable.

Can osteoporosis be reversed?

Bone loss cannot be fully reversed, but treatment and lifestyle changes can slow bone loss and sometimes increase bone density slightly. Weight-bearing exercise, adequate calcium and vitamin D, and medications like bisphosphonates can help maintain or improve bone strength and reduce fracture risk.