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 DEXA (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. Computerized tomography (CT) scans can also be used to check the condition of the bones.
A heel ultrasound test may also be used to test bone density and estimate the risk of fracture for women over 65 years of age. However, heel ultrasound does not provide enough detail to monitor treatment for osteoporosis. If you have a heel ultrasound that detects low bone density, talk to your doctor about having your bone density tested by DEXA.
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.
There are also two tools (CAROC and FRAX) available in Canada for your doctor to use to assess your 10-year absolute fracture risk. 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.