You often don't know you have osteoporosis until a bone breaks

Osteoporosis has no symptoms in its early stages. You can have significantly weakened bones and feel completely normal. Most people discover they have osteoporosis only after a fall causes a fracture — often a wrist, hip, or spine — or after a doctor orders a bone density test for another reason.

The only way to know your bone density before a break happens is through a test called a DEXA scan (dual-energy x-ray absorptiometry). This painless scan measures how dense your bones are and compares them to healthy bone. Your doctor uses the results to tell you whether you have normal bone density, low bone density (called osteopenia), or osteoporosis.

Key Takeaways

  • Osteoporosis causes no pain or symptoms until a bone fractures, so many people have it without knowing.
  • A DEXA scan is the only test that can detect low bone density before a break occurs.
  • Certain risk factors — age, sex, family history, medications, and low body weight — make osteoporosis more likely and may prompt your doctor to order a scan.
  • A fracture from a minor fall or bump, especially in the wrist, hip, or spine, is often the first sign that bone density is dangerously low.
  • Screening guidelines differ for men and women, and your doctor can advise whether testing makes sense for you.

Who should get screened and when

Screening recommendations depend on your age and sex. The U.S. Preventive Services Task Force recommends that all women age 65 and older have a DEXA scan. Women between 50 and 64 should discuss screening with their doctor if they have risk factors — such as a family history of osteoporosis, low body weight, or use of corticosteroid medications.

For men, the recommendations are less uniform. Men age 70 and older may benefit from screening, and younger men with risk factors should talk to their doctor about whether a scan makes sense. If you have had a fracture from a minor fall, your doctor will likely order a DEXA scan regardless of your age.

Your doctor may also recommend screening if you take medications that weaken bone, have a condition that affects bone health (such as rheumatoid arthritis or chronic kidney disease), or have a parent or sibling with osteoporosis.

Signs that might prompt your doctor to order a test

Even without symptoms, certain physical changes or medical history can signal that a DEXA scan would be useful. A sudden loss of height — more than an inch over a few years — can indicate compression fractures in the spine that happened without pain. Stooped posture or a curved upper back (sometimes called a dowager's hump) also suggests spine fractures.

A fracture from a fall that would not normally break a bone in a healthy person is a major red flag. If you tripped and broke your wrist, or fell from standing height and fractured your hip or spine, your bones are likely weaker than normal. Your doctor will order imaging to confirm and will usually recommend a DEXA scan to measure overall bone density.

Certain medications and conditions also raise your risk. Long-term use of corticosteroids (such as prednisone), some cancer treatments, and certain seizure medications can weaken bone. Conditions like celiac disease, inflammatory bowel disease, and hyperthyroidism affect how your body absorbs or uses calcium and vitamin D.

What happens during and after a DEXA scan

A DEXA scan takes about 10 to 30 minutes and involves no needles or injections. You lie on a padded table while a scanning arm passes over your body, usually measuring your hip, spine, and sometimes your forearm. The radiation exposure is minimal — less than you receive from a day of natural background radiation.

After the scan, your doctor receives a report with 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 considered normal. A score between -1.0 and -2.5 means you have low bone density (osteopenia). A score of -2.5 or lower indicates osteoporosis. Your doctor will explain what your score means and discuss next steps, which may include lifestyle changes, calcium and vitamin D, or medications to slow bone loss.

Fractures as a first sign of osteoporosis

Many people learn they have osteoporosis only after breaking a bone. A wrist fracture from catching yourself during a fall, a hip fracture from a minor slip, or a spine fracture from bending or coughing are all common first signs. These fractures happen because bone density has dropped so low that normal stress causes breaks.

If you have had a fracture and are over 50, your doctor should order a DEXA scan to check your bone density. Even if the fracture healed well, knowing your bone density helps your doctor decide whether treatment is needed to prevent future breaks. A second fracture carries much higher risk of disability and loss of independence, so early detection and treatment matter.

Risk factors that increase your chances

Some risk factors you cannot change. Women lose bone density rapidly after menopause due to lower estrogen levels. Men also lose bone density with age, though usually more slowly than women. A family history of osteoporosis or fractures means your genes may put you at higher risk. Being small-framed or having a low body weight also increases risk because you start with less bone mass to draw from as you age.

Other risk factors you can influence. Smoking speeds bone loss and should be stopped. Heavy alcohol use (more than two drinks per day) weakens bone. A diet low in calcium and vitamin D deprives bone of materials it needs to stay strong. Lack of physical activity, especially weight-bearing exercise like walking or strength training, allows bone to weaken. Some medications — including certain blood thinners, some diabetes drugs, and long-term corticosteroids — increase bone loss.

What to ask your doctor

If you are concerned about your bone health, ask your doctor these questions:

  • Based on my age, sex, and medical history, should I have a DEXA scan?
  • Do I have any risk factors for osteoporosis that I should know about?
  • If I have had a fracture, what does that tell us about my bone density?
  • What can I do now to keep my bones as strong as possible?
  • If my DEXA scan shows low bone density, what treatment options are available?
  • How often should I be rescanned to monitor my bone density?

When to seek care

Seek medical attention right away if you have a fall or injury followed by severe pain, swelling, or inability to move a limb normally. Do not assume a fracture will heal on its own — broken bones need proper diagnosis and treatment to heal correctly and to prevent complications.

If you are over 50 and have not had a bone density test, schedule an appointment with your doctor to discuss whether screening is appropriate for you. If you have a family history of osteoporosis or have noticed a change in your height or posture, bring that up with your doctor as well. Early detection and treatment can slow bone loss and reduce your risk of fractures.

Frequently Asked Questions

Can you feel osteoporosis in your bones?

No. Osteoporosis itself causes no pain, tingling, or other sensations. You may not know you have it until a bone breaks. Some people with spine fractures from osteoporosis experience back pain, but many fractures happen without any warning signs.

What does a DEXA scan cost?

Cost varies by location and whether you have insurance. Medicare covers one DEXA scan every two years for women 65 and older and for younger women and men with certain risk factors. Many private insurance plans cover screening as well. Ask your doctor's office what the scan costs with your insurance before scheduling.

How often do I need a DEXA scan?

If your first scan shows normal bone density, you may not need another for 10 years or longer, depending on your age and risk factors. If you have low bone density or osteoporosis, your doctor will usually recommend rescanning every one to two years to see whether treatment is working or bone loss is continuing.

Can osteoporosis be reversed?

Osteoporosis cannot be completely reversed, but bone loss can be slowed or stopped with treatment, exercise, and adequate calcium and vitamin D. Some people can regain a small amount of bone density. The goal of treatment is to prevent further bone loss and reduce fracture risk.

Is osteoporosis hereditary?

Osteoporosis does run in families, but having a parent or sibling with it does not mean you will definitely develop it. Your genes influence how much bone mass you build and how quickly you lose it, but lifestyle factors — diet, exercise, smoking, and alcohol use — also play a major role.