After spending some time with my 80-year-old mom recently, I went to give her a hug and a kiss goodbye when I was struck by how much smaller she’s become. Sure, I’ve been noticing her shrinking stature for at least a few years now, but every so often I still get surprised by how much shorter and less muscular she is throughout her upper body. Also becoming more obvious is the humped back or hunchback she’s developing, just like her mom did in her 80s.

By the time my grandmother died after breaking her hip at age 90, she had classic osteoporosis symptoms, including a severe forward bend in her spine—the “dowager’s hump,” as it’s called. Living for years with osteoporosis left her bones thin, weak, and fragile. This caused silent, tiny fractures in her thoracic vertebrae, the bones in the mid-section her spine. The severe rounding of her upper back was likely a sign of advanced osteoporosis, the result of compression fractures of weakened vertebrae.

What Causes “Hunchback”?

Before the common use of dual-energy x-ray absorptiometry (DEXA) to measure bone mineral density in the early 21st century, the osteoporosis symptoms of fractured vertebrae, height loss, and forward bending of the spine, commonly known as hunchback, were the most frequent presenting complaints. The medical term for hunchback disease is kyphosis; severe kyphosis is known as dowager’s hump.

Kyphosis and height loss are common osteoporosis symptoms. Decreased bone mineral density in the thoracic vertebrae causes compression fractures. Osteoporotic compression fractures usually occur during routine daily activities such as bending of the body, coughing, lifting or some other kind of trivial trauma. Multiple compression fractures, as seen with osteoporosis, cause changes within the structure of the spine that lead to significant height loss and development of kyphosis (dowager’s hump).

Osteoporosis Symptoms from Spinal Fractures

Like most people with osteoporosis, my grandmother likely experienced no symptoms as her bones slowly weakened over the years. Even as her vertebrae fractured, compressed, and deformed, leading to her stooped over position, she may not have felt pain. Neither has my mother, luckily. Up to two thirds of people have no symptoms after these types of vertebral fractures.

Others may suffer from quick onset of pain, which might disappear or turn into chronic, dull, aching, or intermittent back pain and stiffness. Sometimes, compression fractures of the spine cause significant back pain that may be sharp, knifelike, and disabling and which often subsides over a period of weeks to months.

As the thoracic part of the spine curves more severely, it displaces the head and neck forward, causing a compensatory increase in curve in the lower back and pushing the lower abdomen out. Even if it causes no pain, the increased curve of the low back can cause other osteoporosis symptoms such as a protuberance of the abdomen, a change in the way clothes fit, and loss of the waist. Meanwhile, the forward shifting of the head and neck can restrict the ability to look upward and therefore can affect driving and cause difficulty with lying face down.

More severe kyphosis can also cause additional osteoporosis symptoms such as loss of shoulder range of motion. This can interfere with overhead activities of daily living. With severe deformity, balance may also become impaired. Not only is the risk for falls greater, more energy is required for standing and moving around because the spinal balance becomes disrupted and the center of gravity is displaced.

Other osteoporosis symptoms resulting from more severe cases of kyphosis include shortness of breath, fatigue, and poor activity tolerance caused by the rib cage losing its ability to expand with breathing,

How to Prevent Hunchback in Old Age

It may have been too late to save my grandmother from developing her severe dowager’s hump, but my mom still has decent bone mass and great mobility for a woman her age (and a breast cancer survivor, no less).

Studies show hunchback treatment includes staying active, strengthening back muscles along the spine, and slowing bone density loss. Working on her posture and keeping her degenerative arthritis from progressing may also help.

Kyphosis and Osteoporosis/Osteoarthritis

There is new evidence that both poor posture and degenerative disc disease caused by osteoarthritis may also contribute to kyphosis in older people. Researchers recently began noticing that vertebral fractures don’t seem to be responsible for all cases of kyphosis. Simply having weak back muscles, poor posture, or poor health of the vertebral discs associated with degenerative joint disease can increase kyphosis.

Even in cases in which vertebral fractures are osteoporosis symptoms, there is evidence that working on posture and building strength in the back muscles helps improve the kyphosis and keeps it from getting worse.

Women with kyphosis like my mom are not doomed to develop my grandmother’s dowager’s hump. And even though there is clearly a genetic component to kyphosis, neither am I. In addition to trying to eat right, taking our nutritional supplements and using other natural therapies for bone health, we’ll both be working on our posture and strengthening our back muscles with resistance training exercise. Both have been shown to be helpful for reversing kyphosis and other osteoporosis symptoms.

Of course, these are excellent methods for improving many aspects of health, not just for keeping the spine healthy and aligned. Even young, athletic women need to take care to prevent osteoporosis.

Treatments range from taking amino acids to cod liver oil and much more. Start using these strategies today to keep your bones strong as you age.

See also these University Health News posts:

• What Is Osteopenia
• Osteoporosis -2.5: Understanding What Leads to That Bone Mineral Density Score
• Osteoporosis -3.0: What Your T-Score Means for Your Bone Health

This blog originally appeared in 2012 and has been updated by the editors of University Health News. 

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Experts unanimously agree that osteoporosis is far easier to prevent than treat. (The condition is diagnosed via bone mineral density scans known as bone densitometry or dual-energy x-ray absorptiometry, or DXA, also written as DEXA. A “T-score” of osteoporosis -2.5 or -3.0 or lower indicates that you have osteoporosis.) Treating osteoporosis may be difficult, but that does not mean that it cannot be reversed, at least partially, as many studies have demonstrated. Certain natural treatments in addition to some pharmaceuticals have been showed in the scientific literature to rebuild bone and decrease the risk of bone fractures in those with osteoporosis.

Can Osteoporosis Be Reversed? Catch It as Early as Possible

When you lose too much bone, make too little bone, or both, your bones become weak and may break from a minor fall or, in serious cases, even from sneezing or bumping into furniture. This can leave you crippled and in debilitating chronic pain. Fortunately, even weakened osteoporotic bone can become stronger and more flexible again with treatment. Reversing osteoporosis requires more than just a drug, however, and success generally depends on the severity of the osteoporosis at the time treatment is initiated.

Generally, answering the question “Can osteoporosis be reversed without drugs?” depends on how severe and advanced the osteoporosis is and how comprehensive and aggressive the non-drug treatment plan is. The milder the bone loss, the more likely natural osteoporosis treatments can improve bone density.

“Once osteoporosis has been diagnosed, many of the natural interventions such as diet, exercise, nutritional supplementation and herbal medicines could be used aggressively in milder cases to slow bone loss, reduce fracture rates and possibly have a small impact on increasing bone density,” according to Dr. Tori Hudson, ND, a naturopathic physician and well-known expert in women’s health._[1] In more serious osteoporosis cases, she says, the natural intervention will become adjunct to a primary drug therapy such as a bisphosphonate like Fosomax.

Address the Many Underlying Causes of Osteoporosis

In the past, the cause of osteoporosis was considered a hormonal imbalance (primarily a lack of estrogen). But more and more men are suffering from osteoporosis, and research now clearly shows other underlying causes, among them oxidative stress, elevated blood sugar, inflammation, and components of the metabolic syndrome. Reversing osteoporosis requires an aggressive, comprehensive treatment plan that addresses the multiple underlying factors causing the bone loss.

Multi-faceted treatment plans that attack the many underlying causes of osteoporosis by incorporating nutrition, supplements, exercise, and, if necessary, drugs or hormone therapies, can reverse osteoporosis to some extent. Many experts in natural and integrative medicine have put together powerful osteoporosis treatment plans that comprehensively address underlying causes of osteoporosis by utilizing supplements, diet and lifestyle changes, and sometimes other integrative therapies such as hormone optimization using bioidentical hormones.

Common treatments include isoflavones, vitamins K and D, multiple minerals in highly absorptive forms (including strontium), melatonin, antioxidants, essential fatty acids, anti-inflammatory phytonutrients, acid-lowering and anti-inflammatory diets, and bioidentical hormone replacement therapy.

Seeking Effective Natural Osteoporosis Treatments

While many studies have already validated the benefits of these types of natural therapies for osteoporosis, even more studies are currently underway. Naturopathic physician Mark Swanson, ND, is collaborating with Dr. Paula Witt-Enderby and her colleagues at Duquesne University in Pittsburgh on a double-blind, placebo controlled study examining whether melatonin, strontium citrate and vitamins D3 and K2 can treat bone loss in women with thinning bones (osteopenia)._[2]

“Current drug treatments for osteoporosis are not ideal,” Witt-Enderby said in a recent interview._[2] “They have only a 30 percent compliance rate, which really drops after six months. What’s needed is a convenient, safer and better-tolerated treatment. Many women are worried about having to take a powerful drug for months to years before they see results, so a more natural treatment is appealing. In the end, it’s all about safely preventing fractures and improving quality of life.”

For related reading, visit these posts:

• The Role of Vitamin K in Natural Osteoporosis Treatment
• Natural Treatments for Osteoporosis: Amino Acids Can Help Build Strong Bones
• Don’t Ignore This Bone Building Nutrient for Natural Osteoporosis Treatment

Originally published in 2015, this post is regularly updated.

[1] Hudson. T. Osteoporosis: Strategies for prevention and management. (Blog.) 2006 Oct 17. (Accessed Feb 25, 2014.)
[2] Duquesne University Times. Witt-Enderby Conducting Bone Loss Trial. 2013 July 24. (Accessed Feb 25, 2014).

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Certain factors, however, can make you vulnerable to osteopenia, meaning that it’s important to preserve your bone density. Specifically, you’re at greater risk for osteopenia if your diet is poor or if you have an eating disorder. In either case, you likely aren’t consuming the necessary nutrients to support bone health. Lack of exercise also raises your risk, as does a family history of osteoporosis.

Besides poor diet, an eating disorder, or lack of exercise, these risk factors can expose us to osteopenia:

• Being underweight
• Undergoing chemotherapy or radiation to treat cancer
• Fracturing a bone after age 50
• Smoking

You also are more vulnerable to osteopenia if you’re taking long-term corticosteroid medications like those used to treat rheumatoid arthritis and asthma (for example, prednisone) or if you regularly take certain corticosteroids and proton-pump inhibitors, or PPIs (which are used to manage gastroesophageal reflux disease).

What Is Osteopenia?

Osteopenia is a term used to describe low bone density that’s not severe enough to be diagnosed as osteoporosis. With osteoporosis, symptoms may turn up that tell you you’re at risk for fractured or broken bones. With osteopenia, symptoms typically don’t turn up to warn you.

In the absence of osteopenia symptoms, a bone density scan is necessary to diagnose osteopenia. (The procedure also will diagnose osteoporosis -2.5 and osteoporosis -3.0.) How does a bone density scan work? It’s a special type of x-ray that measures—as the name suggests—just how dense your bones are. During a scan, physicians will focus on specific areas of the body—the spinal vertebrae, hips, and wrist area—that are more likely to develop osteoporosis.

A bone density scan reports what’s called a T-score, which compares your bone density to that of a healthy adult at the age of peak bone mass (about age 30). A T-score between -1.0 and -2.5 indicates osteopenia.

Both osteopenia and osteoporosis represent a continuum in the process of natural bone loss that occurs in all women after menopause—and also in many older men—as existing bone cells are broken down (called “resorption”) faster than new bone is made.

How to Fend Off Bone Injury

If you have osteopenia, don’t panic—it doesn’t mean you’re at significantly greater risk for sustaining a bone fracture in the near future. It does mean, however, that you should make sure you’re doing what you can to maximize your bone health. Steps you can take include:

One routine that helps bone strength: physical activity that includes weight-lifting.

• Engaging in weight-bearing exercise (such as walking and lifting weights);
• Ingesting 1,500 milligrams daily of calcium, either in your diet (find it in low-fat dairy and fortified cereals) or through supplementation;
• Taking 700 to 800 international units of vitamin D daily;
• Stopping the habit of smoking;
• Avoiding excessive alcohol.

You also should discuss with your doctor the pros and cons of starting an anti-resorptive medication like alendronate (Fosamax) or ibandronate (Boniva)—generally recommended if your T-score is nudging close to osteoporosis -2.5 or if you have a major risk factor for developing osteoporosis in the next few years.

This article was originally published in 2018. It is regularly updated.

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Research suggests that not enough women who should be getting a DEXA scan are actually receiving them. One 2015 study analyzed the health records of around 51,000 women and found that the DEXA scan was underused in women at increased fracture risk, including women aged 65 years and older. “Meanwhile, it was common among women at low fracture risk, such as younger women without osteoporosis risk factors,” said study author Anna Lee Amarnath, MD, of the University of California, Davis.

Why Would You Need a DEXA Scan?

It’s this incongruity that underpins the question of who should have osteoporosis screening and who should not. Osteoporosis translates as ”porous bones.” That means the micro-architecture of your bones is altered to the extent that they lose their density, becoming less strong and more prone to fracture.

But how do you know whether this process is happening to you, and how are osteoporosis and the therapies designed to treat it monitored over time? This is where a DEXA scan comes in. The information it provides can help you protect yourself against potentially serious bone fractures.

How Does a DEXA Scan Work?

A DEXA scan measures the density of the bones in your spine and hips. The scan is fast, and you shouldn’t need to undress (though you will have to remove any metal, such as jewelry, keys, and belt buckles).

If you’ve been concerned after reading reports about the level of radiation used in tests like DEXA scans, X-rays, and computed tomography (CT) scans, don’t panic—a dexa scan exposes you to a very low dose of radiation. You receive it in two beams: one absorbed by the soft tissue in the area being tested and one absorbed by the bone.

When the amount of radiation absorbed by soft tissue is subtracted from the amount that is absorbed by the bone, the result is your bone density measurement. This is given as a “T-score” used to diagnose whether you have osteoporosis. The range of DEXA scan T-scores used by your doctor is as follows:

• +1 to -1: normal bone density
• -1 to -2.5: osteopenia (low bone density that isn’t severe enough to be diagnosed as osteoporosis)
• -2.5 or lower: osteoporosis

Who Should Have a Dexa Scan?

The United States Preventive Services Task Force (USPSTF)—an independent panel of experts—recommends screening for osteoporosis in women aged 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year old white women who has no additional risk factors.

You also should ask your doctor about having a DEXA scan if you weigh less than 154 pounds, if you have a family history of osteoporosis, if you sustain a fracture after age 50, and if you smoke or regularly drink three or more alcoholic beverages each day.

Health conditions like hyperthyroidism (overactive thyroid), Crohn’s disease, and some medications (including corticosteroids, some antidepressants, and proton pump inhibitors) also may weaken your bones. If you fall into any of these categories, speak to your doctor about having a DEXA scan.

Originally published in 2016, this post is regularly updated.

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What Is Osteoporosis? It Starts with an Imbalance

You may not realize that your bones—like all your body tissues—are metabolically active, and that they change as you grow, mature, and age. This change is enabled by a constant building up and breaking down of bone—a process called remodeling. In remodeling, cells called osteoclasts break down, or resorb, old bone, and cells called osteoblasts form new bone.

Up to about age 50, this system is balanced so that the ratio of new bone to old is maintained. As we get older—and particularly in women, after they go through the menopause—more bone is resorbed than is manufactured.

It’s this imbalance that underpins osteoporosis. In fact, in addressing the question “What is osteoporosis?” it’s important to note that the disease involves, literally, “porous bones” that put you at risk for osteoporotic fractures. And if you’ve already had one osteoporotic fracture, your risk for subsequent fractures increases threefold, according to research presented at the World Congress on Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases in April 2016.

“Untreated osteoporosis is a public health crisis,” says Douglas P. Kiel, MD, MPH, ASBMR, president and director of the Musculoskeletal Research Center and senior scientist for the Institute for Aging Research at Hebrew Senior Life. “Many of us see firsthand the ravages of this disease every day—pain, fractures, loss of mobility and independence, and diminished quality of life.”

Are You at Risk for Osteoporosis?

Understanding your own risk factors for osteoporosis will give you a better idea of how to protect yourself—or it may ease some of your worry.

• You’re more likely to develop osteoporosis if you have a family history of the disease, are excessively thin, went through menopause before age 45, smoke, or drink alcohol to excess.
• Certain medications (such as corticosteroids, used to treat rheumatoid arthritis, and diuretics, given to treat high blood pressure) also raise the risk.
• Women who have received chemotherapy for breast cancer are at increased risk.
• Medical conditions such as celiac disease and Crohn’s disease may boost risk by interfering with calcium absorption.

Men and Osteoporosis

Nearly 1.5 million American men age 65 and older have osteoporosis, and another 3.5 million are at risk for developing it. “Women have a screening safety net,” says Mary Ruppe, M.D., a Houston Methodist endocrinologist. “Between their primary care physician and OB-GYN, women will begin getting a bone density scan at the appropriate age. Men are less likely to have routine primary care checkups and don’t receive preventative care similar to what is provided for women.”

Men should know their bone density scores start getting assessed annually for osteoporosis risk factors from age 50, according to the American College of Physicians. Things that make men vulnerable include female relatives with osteoporosis or parents who suffered a hip fracture, along with using steroids or prostate cancer drugs, gastrointestinal diseases, and excessive alcohol consumption.

The Endocrine Society recommends that all men start routine screening and receive a DEXA Scan for osteoporosis at age 70. DEXA scan results will tell you what your bone density is and if you are at risk of osteoporosis. A bone density T score roughly reflect how much bone you’ve lost—for example, osteoporosis -2.5 equates to 25 percent bone density loss, and osteoporosis -3 equates to 30 percent bone density loss.

How to Preserve Your Bone Density and Treatment for Osteoporosis

“A healthy, balanced diet combined with regular exercise and smart lifestyle choices—such as not smoking and [practicing] moderate alcohol intake—helps set the foundation for strong bones as you age,” says Judy Stenmark, CEO of the International Osteoporosis Foundation. “For those at high risk of fracture due to osteoporosis, a bone-healthy diet also supports falls prevention and enhances the benefits of therapy.

Stenmark adds that calcium should come primarily through food sources. “Supplements may be beneficial if adequate calcium intake cannot be met through the diet, especially where certain medical conditions exist,” she points out. “Anyone with concerns should speak to their doctor who can advise appropriately.”

To lessen your risk of osteoporosis, follow these common-sense tips:

• Get enough calcium. The recommended daily amount for women age 50 and older is 1,200 milligrams (mg), while men should consume 1,000 mg daily up to age 70, and 1,200 mg daily after age 71. Aim to get as much of your calcium as possible via dietary sources (e.g., milk and dairy products, fortified cereals and juices, leafy green vegetables, and canned fish).
• Take a calcium/vitamin D supplement to help make up for any dietary shortfall.
• Participate in weight-bearing exercises regularly. Examples include weight training and walking, which help to build bone.
• Avoid alcohol or drink it in moderation only. Alcohol can inhibit the absorption of calcium. The current recommendation for older adults is no more than one alcoholic beverage daily.
• Quit smoking. Cigarette-smoking is known to raise the risk for osteoporosis.

Originally published in 2016, this post is regularly updated.

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The Downsides of Drugs

Pharmaceutical products can solve the “how to increase bone density” question. There are several effective medicines available for osteoporosis, with varying dosage periods, from daily or monthly to quarterly or annually—and even to once every two years. The drugs are available as pills, injections, sprays, and a patch.

The final decisions on types and dosage will rest with your physician, of course, as these are prescription drugs. However, these medications are not without side effects. The most common: gastrointestinal upsets. And side effects can be as severe as alterations in the bone in your jaw, or even fractures.

“For many people, prescription bone-building medicines should be a last resort,” said Dr. Karen Chapman-Novakofski, a University of Illinois professor of nutrition. The scientist said that prescription bone-building medications are expensive, and that many have side effects—including, ironically, an increase in hip fractures and jaw necrosis. They should be used only if diet and supplements don’t do the trick.

Dr. Chapman-Novakofski reported in an issue of Nutrients that adults who increase their intake of calcium and vitamin D usually increase bone-mineral density and reduce the risk for hip fracture significantly. The results were often accomplished through supplements, but food is also a good source of these nutrients, she said.

Healthy Nutrition and Your Bones

Eating healthy is how to increase bone density at the most basic level. Increase your consumption of vegetables and fruits while maintaining an adequate intake of calcium and vitamin D.

According to the National Osteoporosis Foundation (NOF), calcium-rich foods include the following:

• Collard greens (frozen; 360 mg per 8-oz. serving)
• Broccoli rabe (200 mg per 8-oz. serving)
• Kale (frozen; 180 mg per 8-oz.)
• Sardines (canned with bones; 325 mg per 3 oz.)
• Milk (skim, low-fat, whole; 300 mg per 8-oz. serving)
• Almond milk, rice milk, or soy milk (fortified; 300 mg per 8-oz. serving)
• Waffle (frozen, fortified; 200 mg per 2 pieces)
• Oatmeal, fortified (140 mg per packet)

See the NOF’s chart by clicking here.

As for vitamin D-rich foods, cooked salmon and cooked swordfish are top sources, according to the National Institutes of Health. So too is tuna fish (canned in water); orange juice fortified with vitamin D), milk and eggs.

The NOF recommends that women over 50 and men over 70 get 1,200 mg of calcium daily. For vitamin D, the organization recommends 800 to 1,000 IU daily. (Note: Your primary-care physician may advise you to get more vitamin D, as the currently recommended levels are considered low by many medical experts.)

There are calcium-vitamin D combo supplements available, if you’re concerned you’re not meeting your daily needs. Vitamin D is needed in adequate amounts to ensure your body can absorb the calcium you consume.

Exercise: The Most Important Factor in How to Increase Bone Density

Without argument, the most significant thing you can to maintain bone density is exercise. Weight-bearing and resistance exercises will give you the most benefit. But we don’t mean you need to lift weights, and you don’t need learn any “how-to.” Increase bone density exercise can be as simple as going for a brisk walk. (See our post “The Benefits of Walking.”)

Weight-bearing exercises include doing stair-steppers, aerobics, tennis, and even dancing or yard work. Riding your bike or swimming, however, are not weight-bearing exercises (they’re resistance exercises, see below). Weight-bearing exercises can range from low-impact (like walking or dancing) to high-impact (jogging and tennis). Both will help you succeed in increasing bone density, although you do get more out of the high-impact choices.

One of the most recommended high-impact exercises for improving bone density is jogging. (See our post “The Benefits of Walking vs. Running.”)

Resistance exercises are anything that causes your muscles to contract, so pushing a heavy wheelbarrow, using light dumbbells or a resistance band, working the machines at the health club, and swimming can all help you strengthen your muscles.

While posture and flexibility exercises won’t do much directly to solve your questions on how to increase bone density, they promote overall strength, balance, and smooth movement. Improving these areas will make the weight-bearing and resistance exercises do more for you, and they help with balance issues.

Dr. Chapman-Novakofski suggests a combination of aerobic, strength, balance, and flexibility exercises with a focus on improving your core muscles so you can catch yourself if you start to fall. Whatever sort of exercise you’re doing, you have to introduce new forms of activity every so often because your bones will stop responding to the same old routine and rebuilding will slow, she said.

For further reading, see these posts:

• “Bone Density Chart: Understand Your Bone Density Scores“
• “Osteoporosis -2.5: What Does That Bone Density Test Score Mean to You?“
• “Osteoporosis Exercises: A Proven Exercise Program Involving Strength Training for Building Bone Density“
• “Can Osteoporosis Be Reversed Without Drugs?“

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People with osteoporosis have weak, brittle bones for a variety of reasons, including sex hormone deficiencies or changes; overactive thyroid glands; dietary insufficiencies (particularly calcium and vitamin D); prolonged use of medications such as steroids; and lifestyle factors such as excessive alcohol consumption.

The major concern with osteoporosis is the significantly increased risk of fracture. Statistics demonstrate that approximately 1.5 million people in the U.S. suffer a fracture each year because of bone disease.

Vitamin D deficiency? This can help.

Reasons for a Bone Density Scan

Your healthcare provider may order a bone density scan for you if you’re at risk for osteoporosis or osteopenia for one of many reasons, including:

• Age: Your risk of osteoporosis increases with age. This is particularly true for women whose risk significantly increases after they go through menopause.
• Body frame: Thin men and women generally have less bone mass.
• Family history: Having had a parent or sibling with osteoporosis greatly increases your risk, particularly if they suffered a fracture.
• Hormonal diseases: Overactive thyroid (or hyperthyroidism), parathyroid, and adrenal glands can increase your risk of osteoporosis because of the elevated levels of hormones they produce.
• Medications: Individuals who have taken prolonged courses of steroids, aluminum-containing antacids, some chemotherapy drugs, or some seizure medications (such as Dilantin) are at increased risk of osteoporosis.
• Eating disorder: People suffering from anorexia who have a long history of insufficient calorie and, therefore, calcium and protein intake are more likely to develop osteoporosis. Many people suffering from anorexia will also develop sex hormone deficiencies, further increasing their risk.
• Unexplained fracture: Having suffered a fracture after only very mild trauma or having had evidence of a fracture you were not aware of revealed on another test will raise your healthcare provider’s suspicion of osteoporosis.

What Is the Actual Test Like?

A bone density scan or DXA is generally a very easy, painless outpatient procedure that does not require anesthesia and takes only 10 to 30 minutes. The primary type of DXA used to evaluate osteoporosis is called a “central DXA” because it measures bone density in the hip and lower spine, which are in, roughly, the “center” of the body.

You may have a central DXA performed in a radiologist’s office or in a rheumatologist or endocrinologist’s office. How does it work? You’ll be instructed to lie on a long, flat table that has an x-ray generator underneath and an imaging arm suspended overhead. You’ll likely be positioned in very specific ways to maximize visibility of your hip and spine. The arm of the DXA will pass slowly overhead, taking images of the bone as the x-ray generator sends low-dose beams of x-ray from underneath.

Some people may also have a test called a lateral vertebral assessment (LVA) performed at the same time. This is a very brief test used to assess fractures of the spine and is generally done in people who have experienced a loss of height or unexplained back pain.

What Does “Osteoporosis -2.5” Mean? Interpreting Your T-Score Results

When you receive your bone density scan or DXA results, they’ll be in the form of two scores: a T-score and a Z-score.

• T-Score: The T-score is the result most people refer to when discussing their DXA results. It compares your bone mineral density, no matter what your age, with that of a young adult of your gender who has peak bone mass. The value of your score determines your diagnosis:
  • A T-score of -1 and above is normal.
  • A T-score between -1 and -2.5 is defined as osteopenia or low bone mass.
  • A T-score of -2.5 or below is defined as osteoporosis.

You may hear someone refer to having, for example, osteoporosis -2.5 or osteoporosis -3, which indicates the degree of their osteoporosis.

• Z-Score: The Z-score compares your bone mineral density with other people your age of the same size and gender. Because most older adults have some bone mineral loss, Z scores are most helpful in children, teenagers, and young women still menstruating.
  • A Z-score above -2.0 is considered to be within the expected range for age.
  • A Z-score below -2.0 is considered to be below the expected range for age.

Your healthcare provider will discuss your results with you and may initiate treatment either with lifestyle modifications or medication if your results indicate you have significant osteopenia or if you have osteoporosis. Follow-up bone scans are performed on a regular basis to assess for further bone loss and to monitor your response to treatment.

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The most widely recognized bone mineral density (BMD) test is called a central dual-energy x-ray absorptiometry, or central DEXA scan—also written as DXA scan—with the results expressed as a T-score. It’s painless—a bit like having an x-ray—and can measure bone density at your hip and spine. Peripheral bone density tests measure bone density in the lower arm, wrist, finger, or heel. These tests are often used for screening purposes and can help identify people who might benefit from additional bone density testing.

About the T-Score

Most commonly, your BMD test results are compared to the ideal or peak bone mineral density of a healthy 30-year-old adult. If your resulting T-score is 0, it means your BMD is equal to the norm for a healthy young adult.

Differences between your BMD and that of the healthy young adult norm are measured in units called standard deviations (SDs). The more standard deviations below 0, indicated as negative numbers, the lower your BMD and the higher your risk of fracture.

• A T-score between +1 and −1 is considered normal or healthy.
• A T-score between −1 and −2.5 indicates that you have low bone mass, although not low enough to be diagnosed with osteoporosis.
• A T-score of −2.5 or lower indicates that you have osteoporosis.
• The greater the negative number (osteoporosis -3.0, for example), the more severe the osteoporosis.

Low Bone Mass vs. Osteoporosis

The information provided by a BMD test can help your doctor decide which prevention or treatment options are right for you. A bone mass that’s low but not low enough to be diagnosed as osteoporosis is referred to as osteopenia.

A bone mineral density test uses as a baseline the T-score of a normal, healthy-boned 30-year-old.

Low bone mass can be caused by many factors, among them:

• heredity
• development of less-than-optimal peak bone mass in your youth
• medical condition or medication to treat such a condition that negatively affects bone
• abnormally accelerated bone loss.

Although not everyone who has low bone mass will develop osteoporosis, everyone with low bone mass—osteoporosis -2.5 or higher—is at greater risk for the disease and potential resulting fractures.

As a person with low bone mass, you can take steps to help slow down the process. Your doctor will want you to develop—or keep—healthy habits such as eating foods rich in calcium and vitamin D and doing weight-bearing exercise such as walking, jogging, or dancing. In some cases, your doctor may recommend medication to prevent osteoporosis.

Several effective medications are available to slow or even reverse bone loss. If you do take medication to treat osteoporosis, your doctor can advise you concerning the need for future BMD tests to check your progress.

Who should get a bone density test? The U.S. Preventive Services Task Force recommends that all women over age 65 should have one. Women who are younger than 65 but at high risk for fractures should also have a bone density test.

Originally published in 2016 and regularly updated.

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• Osteoarthritis: Sometimes called “wear and tear” arthritis, osteoarthritis is characterized by a loss of the cushioning cartilage found between the bones of our joints and can cause pain, stiffness, swelling, and decreased mobility. Lifestyle changes—reducing excess body weight, regularly performing exercises that strengthen the muscles that support our joints, and changing from high-impact activities such as jogging to low-impact activities such as walking or swimming—can be helpful in managing symptoms. Additionally, pain can be controlled with acetaminophen or NSAIDs.
• Osteoporosis: The bones in our body are undergoing a constant process of change: old bone is being broken down and new bone is being created. We reach our peak bone mass in our mid-20s, and by middle age, the rate of bone loss tends to increase. This is particularly true of post-menopausal women. In osteoporosis, you either make too little new bone, lose too much old bone, or both. The end result is that the bones become weak and brittle and are prone to fracture, making osteoporosis one of the most common health problems in elderly people. Men and women who have lower bone density by the time the bone loss increases are at increased risk of osteoporosis. (A bone density scan showing a score of osteoporosis -2.5 or osteoporosis -3.0 reveals you to have this condition.)

Other risk factors include a diet low in calcium and vitamin D, a diet high in sodium and caffeine, excess alcohol consumption, history of smoking, sedentary lifestyle, family history of osteoporosis, low body weight/small frame, female gender, history of taking medications known to cause bone loss (such as steroids or aluminum-containing antacids), and being post-menopausal. Treatment can include medications such as bisphosphonates, which slow the breakdown of bone, increasing your calcium and vitamin D consumption, strengthening and weight-bearing exercise, and taking measures to reduce your fall (and, thus, fracture) risk.
• Age-related macular degeneration (AMD): AMD is the leading cause of vision loss in people over the age of 50. It is a degenerative disease of the macula, a part of the eye needed for sharp central vision. While it does not lead to complete blindness, it often results in a blurring of the center of our vision, which can affect daily activities such as reading and driving. Risk factors include a family history of AMD and Caucasian race. Treatment of AMD must be supervised by your doctor and can include a combination of vitamin and mineral supplements (vitamins C and E, zinc, copper, and beta-carotene have proven effective at certain doses) and, in severe cases, injections, photodynamic therapy, or laser surgery.
• Hearing impairment: Hearing occurs because of a complex process of events that occur between our outer, middle, inner ear and the auditory nerve that travels to our brain. As we age, changes often occur in the middle and inner ear that diminish our hearing, making impairment one of the most common health problems in elderly people. Additionally, a long history of exposure to loud noises can irreparably damage the hair cells in our inner ear that are critical to the hearing process. Treatment for age-related hearing loss can include hearing aids, telephone amplifiers, or cochlear implants.
• Age-related urinary incontinence: There are four main categories of urinary incontinence that can affect the elderly. They are typically a combination of the effect aging has on our muscles combined with the anatomic or physiologic effects of another condition:
  • Urge incontinence: This is the most common cause of incontinence in the elderly and is characterized by early, forceful contractions of a muscle in the bladder wall resulting in frequent small to moderate losses of urine even when the bladder is not full. Risk factors for urge incontinence are a history of stroke, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, pelvic organ prolapsed, or benign prostatic hyperplasia (BPH). Treatment includes pelvic floor muscle exercises and anti-spasmodic medications.
  • Stress incontinence: This is more common in early menopausal women or younger elderly women who have had multiple vaginal childbirths. It is characterized by leakage of urine with increases in intra-abdominal pressure such as coughing, sneezing, laughing, or exercise. Pelvic floor muscle exercises, hormone therapy, and surgery are among the options for treatment.
  • Overflow incontinence: This is characterized by a diminished urinary stream and the sensation of incomplete voiding and can result because of outlet obstruction (as in BPH or severe pelvic organ prolapse) or a dysfunction in bladder contractility (as in diabetic neuropathy or spinal cord nerve compression syndromes). Treatment depends on the underlying cause but can include surgery or medications.
  • Functional incontinence: This is associated with cognitive impairment or loss of mobility that impairs an individual from accessing a restroom. Use of disposable protective undergarments and planned, assisted bathroom visits can be helpful management options.
• Age-related skin conditions: A number of changes occur in the skin with age, including thinning of the skin, loss of ability to retain water in the skin, and a loss of moisturizing glands in the skin, resulting in dryness, loss of immune cells in the skin resulting in decreased wound healing, and a loss of elasticity. Some of these effects can be managed by regular moisturizing and inspection of the skin for sores such that prompt treatment can be initiated to avoid infection. Other skin disorders that can occur are:
  • Skin cancers: These are commonly the result of sun exposure. It is important to see your dermatologist regularly so that he or she can check for skin cancers.
  • Age spots: These are flat tan or brown spots that usually develop in areas that have been exposed to sun. If they are true age spots they are harmless, but your healthcare provider should inspect any irregular spot.
  • Bed sores/pressure ulcers: These are lesions that typically develop because of increased pressure on certain areas of the body from remaining in the same position for prolonged periods of time. They usually develop in people with decreased mobility or in people with diabetes who have impaired circulation and immunity. Management involves frequent position changes to alleviate the pressure on the sores and good skin hygiene.

Originally published in May 2016 and updated.

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The bones in our body are in a continual state of change. Old bone is constantly being reabsorbed and new bone is being created. The balance between the two processes is critical to having strong, healthy bones. When bone reabsorption exceeds the rate of new bone formation, the net effect is bone loss and lower bone density.

What Is Osteopenia? Explaining Bone Density

Osteopenia and osteoporosis guidelines show them to be essentially different stages on a spectrum of bone density, with osteoporosis representing the lowest bone density and osteopenia representing a state between normal bone density and osteoporosis.

It is estimated that approximately 44 percent of American adults have low bone density, and evidence has shown that the risk of suffering a fracture increases as bone mineral density declines.

Osteopenia: Diagnosis and Test Scores

The diagnosis of osteoporosis or osteopenia is most often made by performing a bone mineral density scan or dual-energy x-ray absorptiometry (DXA). This is generally a very easy, painless outpatient procedure that does not require anesthesia and takes only 10 to 30 minutes.

The primary type of DXA used to evaluate bone mineral density is called a central DXA because it measures bone density in the hip and lower spine, which are in the “center” of the body. You may have a central DXA performed in a radiologist’s office or in a rheumatologist or endocrinologist’s office.

Do I Need a Bone Density Scan?

The decision to have a bone density scan is one you will make with your healthcare provider based on your risk factors, which can include:

• Age: Your risk of osteoporosis increases with age. This is particularly true for women whose risk significantly increases after they go through menopause.
• Body frame: Thin men and women generally have less bone mass.
• Family history: Having had a parent or sibling with osteoporosis greatly increases your risk, particularly if they suffered a fracture.
• Hormonal diseases: Overactive thyroid, parathyroid, and adrenal glands can increase your risk of osteoporosis because of the elevated levels of hormones they produce.
• Medications: Individuals who have taken prolonged courses of steroids, aluminum-containing antacids, some chemotherapy drugs, or some seizure medications (such as Dilantin) are at increased risk of osteoporosis.
• Eating disorder: People suffering from anorexia who have a long history of insufficient calorie and, therefore, calcium and protein intake are more likely to develop osteoporosis. Many people suffering from anorexia will also develop sex hormone deficiencies, further increasing their risk.
• Unexplained fracture: Having suffered a fracture after only very mild trauma or having had evidence of a fracture you were not aware of revealed on another test will raise your healthcare provider’s suspicion of osteoporosis.

The National Osteoporosis Foundation recommends bone density measurement for all women 65 and older, women under 65 who have one or more risk factors, and postmenopausal women with a history of fracture.

What Should My Bone Density Be?

Your bone density scan or DXA results will be reported as a T-score and a Z-score. The T-score compares your bone density with that of a young adult of the same gender who has peak bone mass. The Z-score, which is less often used, compares your bone density with that of people your age, gender, and size. T scores have been defined such that:

• A T-score above -1 is normal
• A T-score between -1 and -2.5 defines osteopenia
• A T-score of -2.5 or less defines osteoporosis

While each disease has its own score, it is important to remember that they represent a continuum. Someone with osteoporosis -2.5 may not have significantly different bone density from someone with osteopenia and a T score of -2.4.

There are many official recommendations for the treatment of osteoporosis, but the management of osteopenia can vary. Most experts will recommend that people with osteopenia who have not suffered a fracture and whose T-score is closer to -1 should manage their osteopenia with lifestyle modifications such as dietary changes (to increase calcium and vitamin D intake), regular exercise (particularly weight-bearing exercise), moderation in alcohol consumption, and smoking cessation.

Those individuals who have suffered a fracture or whose T-score is closer to osteoporosis -2.5 should be treated more aggressively. This may include lifestyle modifications as well as medications such as alendronate (Fosamax), risedronate (Actonel), or raloxifene (Evista). Additionally, your healthcare provider will likely want you to have follow up bone density scans every two years to monitor changes in your bone density and to assess your response to treatment.

Originally published in March 2016 and updated.

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