Osteoporosis and Bone Density
Osteoporosis is lower bone density or bone mass, or a change in bone structure, so a fracture is more likely. It often stays silent until the hip, spine, or wrist breaks after a standing-height fall or a strain such as a cough. This page is for adults 50 and older. Any central DXA order is done outside and does not confirm a center or a date. Under 50, use primary care. No named provider has signed this draft.
Symptoms and questions to discuss
- Often no warning until a bone breaks
- Sudden severe back pain, height loss, or a stooped posture
- A hip, spine, or wrist break after a low fall or minor strain
What we check
- Risk factors, prior fractures, height loss, and steroid use
- Whether the visit is screening or care after a fragility fracture
- A shared decision for men, because screening evidence is insufficient
- Which outside center gets the order and who reads the returning report
Treatment options by class
Your provider reviews appropriate options and follow-up based on your assessment.
- Outside central hip and spine DXA when indicated
- Calcium, vitamin D, and protein from food before a supplement
- Walking and balance work without sudden high-impact strain
- A class that slows bone loss or supports formation, only if fracture risk supports it
When we refer
Primary care may order outside central DXA and explain the report. Complex bone loss goes to endocrinology or rheumatology. Possible repair goes to orthopedics. A therapy request is not an opening. Heel ultrasound does not replace diagnostic DXA. A validated forearm DXA may be appropriate in selected circumstances; the interpreting provider selects the site. Under 50, use primary care. Head injury, inability to bear weight, face drooping, trouble speaking, and sudden weakness need emergency care.
Screening is not fracture care
Women 65 and older are offered central DXA. Younger postmenopausal women need a risk factor and a clinical tool first. Factors include low weight, a parent hip fracture, smoking, and excess alcohol. Men have insufficient evidence, not a refusal. From age 70 they may discuss a scan. Known osteoporosis, a fragility fracture, long-term steroids, or other secondary bone loss needs treatment review, not screening alone.
What the T-score means
Central DXA of the hip and spine uses low radiation. After menopause, and in men 50 and older, -1.0 or higher is usual, below -1.0 and above -2.5 is low bone mass, and -2.5 or lower supports osteoporosis if nothing else explains it. A spine or hip fracture can still mean osteoporosis. Heel ultrasound and peripheral screening tests do not replace diagnostic DXA. A validated one-third-radius forearm DXA can support diagnosis in selected situations, such as when the hip or spine cannot be interpreted. The interpreting provider selects the appropriate site.
Limits of the first bone plan
Food first for calcium, vitamin D, and protein. The provider sets any supplement. No dose chart is here. In older adults, exercise helps muscle and balance and does not increase bone mass. Avoid high-impact strain if bone is fragile. A class that slows loss, or one that supports formation, follows fracture risk. This page starts no medicine. Do not stop a steroid or specialty medicine yourself. Quit smoking. Limit alcohol to one drink a day for women and two for men.
Who reads the report
The outside center should send the report to the ordering Viva provider. Confirm arrival. That provider explains the score. No turnaround is stated. Repeats every 4 to 8 years did not improve fracture prediction, though a lower starting score can change sooner. After a medicine starts or changes, repeat central DXA is often considered in 1 to 2 years. Call 911 for head injury, a deformed limb, chest pain, trouble breathing, or one-sided weakness. New severe back pain or sudden height loss needs same-day care.
Frequently asked questions
Does every adult 50 or older need DXA?
No. It is routine for women 65 and older, and earlier only after a risk review. Under 50, use primary care.
Will Viva perform the DXA?
No. It is done outside. No center or date is named. Buttons or zippers over the hip or spine can spoil the picture.
Is low bone mass osteoporosis?
No. A T-score below -1.0 and above -2.5 is low bone mass. Fracture history and a validated DXA report guide care; heel screening is not equivalent. The interpreting provider may choose one-third-radius DXA in selected situations.
Can medicine restore young bone?
No. A class that slows loss, or one that supports formation, may lower fracture risk. It does not restore young bone. Do not stop it yourself.
Who explains the report?
The ordering provider does. If another specialty is involved, Viva keeps interim questions until that office sees you. Emergencies go to 911.
Sources
- Osteoporosis to Prevent Fractures: Screening — U.S. Preventive Services Task Force
- Osteoporosis — National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH)
- Osteoporosis: Diagnosis, Treatment, and Steps to Take — National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH)
- Evaluation of Bone Health and Bone Density Testing — Bone Health and Osteoporosis Foundation
Content approved by Viva Centers