Diagnosing Osteoporosis & Low Bone Mass

NYU Langone doctors are experts in diagnosing osteoporosis and low bone mass, or a loss in bone density. Throughout a person’s lifetime, bones are continually breaking down and rebuilding themselves to remain strong. When you’re young, your body makes new bone faster than it breaks down old bone, so your bone mass—the amount of calcium and other matter that comprise the bones—is relatively dense, meaning the bones are stronger.

Most people reach their peak bone mass by age 30. Bone mass stays relatively steady for the next 20 years. After women reach menopause, usually around age 50, and around the same time in men, bone mass is lost faster than it’s created, which leads to weakening of the bones. This is referred to as low bone mass.

People who have low bone mass are at risk for developing osteoporosis, a condition in which bone mass is so low that a person’s bone strength is compromised. People with osteoporosis have a greater risk of fracturing, or breaking, a bone than those who don’t have the condition.

Osteoporosis and low bone mass are very common in the United States. In fact, 40 to 50 percent of women and 25 percent of men over age 50 have an osteoporosis-related fracture.

Bone strength is defined in terms of bone density, or the density of the minerals in your bones, and bone quality, which refers to the bone’s internal structure. Having enough of both components helps determine whether your bones are strong and flexible enough to withstand pressure. If you have osteoporosis, your bones become weak and thin, and are therefore less likely to withstand the pressure of a fall.

Signs and Symptoms

Osteoporosis is often referred to as a silent disease because you can't feel your bones becoming thinner or weaker. A type of fracture called a fragility fracture is often the first indication that you have the condition. A fragility fracture is a break in a bone from a minor fall, often from standing height, which probably wouldn’t cause a fracture in someone with healthy bones.

Broken bones caused by osteoporosis are most likely to occur in the hip, spine, pelvis, upper arm, and wrist, but other bones can break as well.

Other signs of osteoporosis are a loss of height and an increased curvature of the spine. This occurs due to compression fractures, in which bones in the spine, known as vertebrae, begin to break or collapse. This can decrease the length of the spine and cause it to curve. Chronic pain may develop as the spine becomes more curved.

Risk Factors

How likely you are to develop osteoporosis depends partly on how much bone mass you acquired when you were young. The higher your peak bone mass, the more bone you can draw from as you age. Women are at higher risk for osteoporosis than men as they age because the loss of the hormone estrogen after menopause causes significant bone loss. Genetic influences also play a role.

Long-term use of corticosteroids is strongly associated with osteoporosis because these medications deplete bone. Having certain hormonal conditions, such as hyperthyroidism, hyperparathyroidism, and Cushing’s syndrome can also put you at risk because the excessive levels of hormones associated with these conditions can diminish bone formation or increase bone breakdown.

Diagnostic Tests

Because osteoporosis and low bone mass may not have discernible symptoms, a diagnosis is often made after the disease has already weakened the bones. NYU Langone doctors can tell you, based on your overall health and risk factors, whether you might benefit from regular bone density screenings, so doctors can assess your bone strength and identify any changes that have occurred.

If you're injured in a fall, you should go to an emergency room or to your doctor to have the injury examined. Doctors may also order tests to assess your bone health, including the following.

X-ray

An X-ray is a simple and reliable diagnostic technique that uses high frequency beams of light to provide doctors with images of the body. This is often the first test a doctor orders if you have injured yourself in a fall or the doctor suspects you have broken a bone.

X-rays alone cannot tell your doctor whether you have osteoporosis, but they can reveal minor fractures in the spine that might be a result of the condition. If your doctor notices these, he or she may recommend a bone density test to obtain additional information about your bone health.

Bone Density Test

If your doctor suspects you may have osteoporosis after a fall, or from symptoms or risk factors, he or she may refer you for a dual energy X-ray absorptiometry scan, commonly known as a DEXA scan, or a bone density scan. It is a common screening test and is considered the gold standard of diagnostic tests for osteoporosis and low bone mass.

You may be diagnosed with low bone mass or osteoporosis by your family physician, internist, or orthopedist. Next, your doctor may refer you to an endocrinologist—a physician who specializes in hormonal disorders and metabolic bone disease—to determine the best treatment for you.