Osteoporosis

Diagnosis

Healthcare professionals often diagnose osteoporosis during routine screening for the disease. It also is commonly diagnosed when a broken bone is X-rayed. Sometimes osteoporosis is found when you have an X-ray for another reason, such as a chest X-ray.

Your health professional may perform a physical exam to check for changes in your height and posture, among other things. Your health professional may order a test to check your bone density.

Your bone density can be measured with a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only certain bones are checked — usually those in the hips and spine.

Treatment

Treatment recommendations are often based on the results of your bone density test and your Fracture Risk Assessment Tool (FRAX) score. The FRAX score is an estimate of your risk of breaking a bone in the next 10 years. If your risk isn't high, treatment might not include medicines and might focus instead on modifying risk factors for bone loss and falls.

Bisphosphonates

For people at increased risk of broken bones, the most widely prescribed osteoporosis medicines are bisphosphonates. Examples include:

• Alendronate (Binosto, Fosamax).
• Risedronate (Actonel, Atelvia).
• Ibandronate.
• Zoledronic acid (Reclast, Zometa).

Side effects include nausea, abdominal pain and heartburnlike symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don't cause stomach upset but can cause fever, headache and muscle aches.

A very rare complication of bisphosphonates is a break or crack in the middle of the thighbone. Another rare complication is delayed healing of the jawbone, called osteonecrosis of the jaw. This can occur after an invasive dental procedure, such as removing a tooth.

Denosumab (Prolia, Xgeva)

Compared with bisphosphonates, denosumab produces similar or better bone density results and reduces the chance of all types of breaks. Denosumab is delivered via a shot under the skin every six months.

Similar to bisphosphonates, denosumab has the same rare complication of causing breaks or cracks in the middle of the thighbone and osteonecrosis of the jaw. If you take denosumab, you might need to continue to do so indefinitely. Recent research indicates there could be a high risk of spinal column fractures after stopping the medicine.

Hormone-related therapy

Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of breast cancer and blood clots, which can cause strokes. Therefore, estrogen is often used for bone health in younger women or in women whose menopausal symptoms also require treatment.

Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women without some of the risks associated with estrogen. Taking this medicine can reduce the risk of some types of breast cancer. Hot flashes are a possible side effect. Raloxifene also may increase your risk of blood clots.

In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medicines have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Bone-building medicines

If the more common treatments for osteoporosis don't work well enough, your healthcare professional might suggest trying:

• Teriparatide (Bonsity, Forteo). This powerful medicine is similar to parathyroid hormone and stimulates new bone growth. It's given by daily injection under the skin for up to two years.
• Abaloparatide (Tymlos). This is another medicine similar to parathyroid hormone. This medicine can be taken for only two years.
• Romosozumab (Evenity). This is the newest bone-building medicine to treat osteoporosis. It is given as an injection every month at your healthcare professional's office and is limited to one year of treatment.

After you stop taking any of these bone-building medicines, you generally need to take another osteoporosis drug to maintain the new bone growth.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

These suggestions might help reduce your risk of developing osteoporosis or breaking bones:

• Don't smoke. Smoking increases rates of bone loss and the chance of fracture.
• Limit alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Alcohol use also can increase your risk of falling.
• Prevent falls. Wear low-heeled shoes with nonslip soles. Check your house for electrical cords, area rugs and slippery surfaces that might cause you to fall. Keep rooms brightly lit. Install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.

Preparing for your appointment

Your healthcare team might suggest bone density testing. Screening for osteoporosis is recommended for all women over age 65. Screening also may be recommended for some postmenopausal women younger than 65 who are at higher risk of developing osteoporosis. Some guidelines also recommend screening for men by age 70, especially if they have health issues likely to cause osteoporosis.

If you have a broken bone after a minor force injury, such as a simple fall, bone density testing may be important to assess your risk of more breaks.

If the test results show very low bone density or you have other complex health issues, you might be referred to a specialist in metabolic disorders, called an endocrinologist, or a specialist in diseases of the joints, muscles or bones, called a rheumatologist.

Here's some information to help you get ready for your appointment.

What you can do

• Write down symptoms you've noticed, though it's possible you may not have any.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements that you take or have taken, including doses. It's especially helpful if you record the type and dose of calcium and vitamin D supplements because many different preparations are available. If you're not sure what information you might need, take the bottles with you or take a picture of the label with your smartphone and share it with your care team.
• Write down questions to ask your healthcare team.

For osteoporosis, basic questions to ask your care team include:

• Do I need to be screened for osteoporosis?
• What treatments are available, and which do you recommend?
• What side effects might I expect from treatment?
• Are there alternatives to the treatment you're suggesting?
• I have other health conditions. How can I best manage them together?
• Which activities are best for me?
• Do I need to change my diet?
• Do I need to take supplements?
• Is there a physical therapy program that would benefit me?
• What can I do to prevent falls?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Have you fallen?
• Have you broken bones?
• Have you gotten shorter?
• How is your balance?
• How is your diet, especially your dairy intake? Do you think you get enough calcium? Vitamin D?
• How often do you exercise? What type of exercise do you do?
• Do you have a family history of osteoporosis?
• Has a parent broken a hip?
• Have you ever had stomach or intestinal surgery?
• Have you taken corticosteroid medicines, including prednisone or cortisone, as pills, injections or creams?