Osteoporosis - Diagnosis and Treatment

Diagnosis

Doctors usually spot osteoporosis with a special test called a DEXA scan (dual-energy X-ray absorptiometry). This scan uses low levels of X-rays to measure bone mineral density (BMD), mainly in the hip and spine.

It lets doctors check for low bone mass and see if someone’s at risk for future fractures.

Doctors usually provide DEXA results as a T-score, which indicates whether your bone density is normal, low (a condition called osteopenia), or low enough to be classified as osteoporosis.

The lower the T-score, the greater the degree of bone loss and the higher the risk for fractures.

Based on your medical history, your doctor may recommend earlier screening if you have known risk factors such as:

Postmenopausal status without hormone therapy
A family history of osteoporosis
Certain medical conditions (like rheumatoid arthritis or thyroid disorders)

To identify contributing factors or rule out secondary causes of bone loss, your doctor may also order blood tests, such as:

Thyroid-stimulating hormone (TSH) – to screen for thyroid disorders.
Creatinine – to evaluate kidney function.
25-hydroxyvitamin D – to measure vitamin D levels.

In cases where a DEXA scan isn’t available, or when further investigation is needed, other imaging tests like quantitative computed tomography (QCT) or ultrasound may be used to assess bone quality.

Treatment

Medications That Slow Bone Loss

Doctors often begin treatment with a class of drugs called bisphosphonates for individuals at higher risk of osteoporosis-related fractures. These medications work by slowing down bone loss and helping maintain bone density.

Bisphosphonates are available in both oral and intravenous (IV) forms. Oral bisphosphonates are typically taken daily, weekly, or monthly, depending on the specific formulation and patient needs.

For those who have difficulty with pills or gastrointestinal side effects, an IV form may be given once a year.

Some people may experience mild side effects, such as nausea or stomach discomfort, particularly if the pills are not taken with plenty of water or on an empty stomach.

Antibody Injections for Bone Loss

One treatment option for people who need extra protection from bone fractures is a monoclonal antibody therapy. This type of medication helps reduce bone breakdown and can be especially helpful for individuals at higher risk for fractures.

This antibody is given as a subcutaneous injection (under the skin) every six months. It works by blocking a protein that speeds up bone loss, helping the body preserve bone strength.

Stopping the medication suddenly can increase the risk of spinal fractures, so any treatment changes should be monitored by a doctor.

Hormone-Based Approaches

Some treatments use hormones or hormone-like medicines to keep bones strong.

Estrogen therapy can help women right after menopause, but it isn’t for everyone since it can raise the risk of blood clots and some cancers
Doctors weigh your age, health, and risks before prescribing it.
Selective estrogen receptor modulators (SERMs) act like estrogen in the bones and are mostly used for women after menopause to help maintain bone density.
It doesn’t carry all the risks of estrogen, but blood clots and hot flashes can still happen.
For men, osteoporosis sometimes links to low testosterone.
In some cases, testosterone replacement helps, but usually, doctors stick with osteoporosis drugs tested specifically for men.

All hormone-based treatments need close doctor supervision to balance benefits and risks.

Medicines That Build New Bone

If your bones are very weak or other treatments aren’t working, your doctor might recommend bone-building medications, also known as anabolic agents. These drugs help your body form new bone and are typically used for a set period of time.

Some leading options include:

Drug Name	How It’s Taken	Limit of Use
Parathyroid hormone analog	Daily shot, under the skin	Up to 2 years
Parathyroid hormone–related peptide analog	Daily shot, under the skin	Up to 2 years
Sclerostin-inhibiting antibody	Monthly shot, at clinic	Up to 1 year

Parathyroid hormone analogs and peptide-related agents help the body build new bone by mimicking the effects of natural bone-forming hormones.
A sclerostin-inhibiting antibody is a newer option that stimulates bone growth quickly but is generally limited to one year of use.

After completing a round of these medicines, your doctor will likely switch you to a bisphosphonate to help maintain the new bone.

This plan gives your bones lasting strength and helps prevent fractures. These treatments bring hope for those who need extra help, but each one has its own steps and rules.

Everyday Choices and Home Tips

Good habits help protect your bones and lower the risk of fractures and pain. A healthy diet with enough calcium and vitamin D keeps your bones strong.

Vitamin D supplements and more time outside can help boost your vitamin D levels. Exercise matters, especially weight-bearing activities like walking or strength training.

These keep your bones strong and improve your balance.

You’re less likely to fall or get hurt, including hip or spine fractures.

Don’t smoke.
Limit alcohol to two drinks or fewer per day.
Prevent falls with safe shoes, clear walkways, and grab bars in bathrooms.

Making these changes may also help prevent bone loss as you age or go through menopause.

Getting Ready for Your Visit

Getting ready helps your health care team give you the best care.

Try these steps:

What to Write Down	Why It Matters
Symptoms	Helps spot warning signs early
Life changes or major stress events	Gives useful background context
Medicines and supplements	Prevents drug interactions
Questions for your doctor	Keeps important topics from being missed

1. List Any Symptoms: Write down any changes or symptoms, even if they seem minor. Some people with bone issues don’t have obvious symptoms.

2. Note Important Life Events: Jot down any major stresses, changes, or events in your life that might affect your health.

3. Record Your Medicines and Supplements: Make a list of all your prescription and over-the-counter medicines, vitamins, and supplements. If you’re not sure, bring the bottles or photos of the labels to your doctor.

4. Prepare Your Questions: Take a little time to write out your questions. This helps you remember what to ask and gives you peace of mind.

Think about topics like:

Do I need bone density screening?
What treatment choices are there?
What are the possible side effects of these treatments?
Are there other options besides medicine?
How do my other health problems affect my bone health?
Should I change my diet or take supplements?
Is physical therapy a good choice?
How can I lower my risk for falls?

Don’t worry about asking too many questions. Your healthcare team is there to help you.

Questions Your Doctor Might Ask

When you visit, your doctor or specialist will want some clear details about your health. It helps to be ready for these questions, since it can make the whole thing go a lot smoother:

Have you ever broken a bone?
Have you noticed yourself getting shorter lately?
What do you usually eat? Do you get much dairy, calcium, or vitamin D?
Do you exercise? What kind, and how often?
Have you lost your balance or taken a fall recently?
Does anyone in your family have weak bones?
Did either of your parents ever break a hip?
Have you had any stomach or bowel surgery?
Have you taken corticosteroids—pills, injections, or creams?

If you bring all the details, your provider can give you better guidance and support.

Sometimes, if your bone density is low or your health situation is a bit complicated, your doctor might send you to a specialist, like an endocrinologist or rheumatologist, to help you manage your bone health.

Osteoporosis – Diagnosis and Treatment