The key steps for diagnosing osteoporosis involve assessing your risk for fracture and evaluating your bone density.
If your doctor determines that you do have risk factors for fracture or osteoporosis (such as being 65 years or older or having had a fracture in the past), there are several effective and relatively quick tests that measure bone mineral density (BMD). If the results show that your bone density is too low, your doctor will likely diagnose you with osteoporosis.
Bone density measurement by a method called DXA (dual energy X-ray absorptiometry) is the most effective way to assess osteoporosis risk. Scanning parts of the body such as the hips or spine using a special type of X-ray machine can confirm you have an increased risk of fractures. The test compares your bone density to that of a typical healthy adult at age 25, the usual age of maximum bone density.
Sometimes a computerized tomography (CT) scan or a heel ultrasound may also be used to check the condition of the bones.
Following the diagnosis of osteoporosis, further studies are needed to look for possible causes. An examination to determine such causes might involve blood and urine tests to measure the levels of certain hormones produced in the body, as well as questionnaires on lifestyle and diet, to help determine your daily intake of calcium and vitamin D.
There are also two tools (CAROC and FRAX) available in Canada for your doctor to use to calculate an estimate of future risk of fracture or bone breaking in the next 10 years. To determine your personal risk of fracture over the next 10 years, your doctor will take into consideration key risk factors which may include: age, gender, body mass index, fracture history, family history, use of corticosteroids, smoking status, and alcohol intake.
If your doctor decides that you require medication to treat osteoporosis, BMD testing may be conducted every 1 to 3 years to see if the therapy is working. Once the medication is shown to be effective, you may not need to be tested as often. BMD testing may also be repeated to monitor for rapid bone loss in people who are not started on medications for osteoporosis but are at risk for developing the disease.