What osteoporosis is
Osteoporosis means bones have become thinner and weaker, so they break more easily. A fracture can happen from a fall from standing height or even a strong cough or bend. The hip, spine and wrist are common sites. Spine fractures can be silent and may only show up as lost height or a curved upper back.2
Because there are usually no warning signs, screening is how most people find out.
Who should be screened?
In January 2025, the US Preventive Services Task Force (USPSTF) updated its recommendation:1
- Women 65 and older: screening is recommended (grade B).
- Postmenopausal women younger than 65 who are at increased risk based on a formal risk assessment: screening is recommended (grade B).
- Men: the USPSTF found the evidence insufficient to recommend for or against routine screening (an "I" statement).
Other expert groups go further for men. The Bone Health & Osteoporosis Foundation (BHOF) guide recommends bone density testing for men 70 and older, and for men 50 to 69 with risk factors.2 If you are a man with risk factors, it's reasonable to ask whether testing makes sense for you.
Common risk factors
Risk factors that can lead to earlier testing include:24
- a previous fracture from a minor fall as an adult,
- a parent who broke a hip,
- long-term use of steroid (glucocorticoid) medicines such as prednisone,
- smoking, or drinking three or more alcoholic drinks a day,
- low body weight,
- early menopause, or low sex hormone levels in men,
- conditions such as rheumatoid arthritis, overactive thyroid or parathyroid, celiac disease, and some medicines used for breast or prostate cancer.
How a DXA scan works
The standard screening test is a DXA (dual-energy X-ray absorptiometry) scan of the hip and lower spine. You lie on a padded table for a few minutes while a scanner arm passes over you. It's painless, and the radiation dose is very low—much less than a standard chest X-ray.2
Tips: wear clothes without metal zippers or buttons, and if you take calcium supplements, ask whether to skip them for 24 hours before the scan.
Making sense of T-scores
Your report compares your bone density with that of a healthy young adult. This comparison is the T-score:24
| T-score | Category |
|---|---|
| −1.0 and above | Normal bone density |
| Between −1.0 and −2.5 | Low bone mass (sometimes called osteopenia) |
| −2.5 and below | Osteoporosis |
A T-score is only part of the story. Someone who has already had a hip or spine fracture from minor trauma may be diagnosed with osteoporosis even if the T-score is not that low.4
FRAX: your 10-year fracture risk
Many reports also include a FRAX score. FRAX combines bone density with risk factors like age, prior fracture and steroid use to estimate your chance of a major fracture and of a hip fracture over the next 10 years. In the US, treatment is commonly considered when the 10-year risk is 20% or more for a major fracture or 3% or more for a hip fracture, along with other clinical factors.2
If you have osteoporosis or high risk
An endocrinologist will usually look for causes that can be treated, such as low vitamin D, overactive parathyroid glands, thyroid hormone excess, or medicines that weaken bone. Blood and sometimes urine tests help with this.4
For postmenopausal women at high fracture risk, the Endocrine Society recommends medicine to lower fracture risk, with bisphosphonates often used first. Other options include denosumab and, for very high risk, bone-building medicines such as teriparatide, abaloparatide or romosozumab.3 The best choice depends on your risk, kidney function, other conditions and preferences. Medicines are only part of the plan.
Everyday ways to protect your bones
- Calcium and vitamin D: aim to get enough, mostly from food. The BHOF guide suggests about 1,000 mg of calcium a day for men 50–70 and 1,200 mg for women 51 and older and men 71 and older, and 800–1,000 IU of vitamin D for adults 50 and older. Ask before adding supplements.2
- Move: weight-bearing exercise (like walking) and muscle-strengthening help bones; balance training such as tai chi helps prevent falls.
- Prevent falls: good lighting, removing loose rugs, grab bars and checking vision all help.
- Limit risks: don't smoke, and keep alcohol to moderate levels.
This article is general education. Whether and when you need screening or treatment depends on your history; please discuss it with your clinician.
Sources & references
- US Preventive Services Task Force (Nicholson WK, Silverstein M, Wong JB, et al.). Screening for osteoporosis to prevent fractures: US Preventive Services Task Force recommendation statement. JAMA. 2025. doi:10.1001/jama.2024.27154. View source
- LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022;33(10):2049–2102. doi:10.1007/s00198-021-05900-y. View source
- Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595–1622. doi:10.1210/jc.2019-00221. View source
- Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocr Pract. 2020;26(Suppl 1):1–46. doi:10.4158/GL-2020-0524SUPPL. View source
Guidelines are updated over time. Links point to the publisher or DOI record; always check for the newest version.