Osteoporosis Symptoms and Signs, and Where a DEXA Scan Fits

The NHS describes osteoporosis as a health condition that weakens bones, making them fragile and more likely to break. The NHS says it develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break.

That is why searching for osteoporosis symptoms can be confusing. The Royal Osteoporosis Society explains that when people talk about the symptoms of osteoporosis, they are really talking about the broken bones it causes. This guide covers those signs, who is most at risk, and how a DEXA scan is used.

Osteoporosis usually has no symptoms until a bone breaks

The NHS says osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain. The bones that most often break are the wrist, the hip and the bones of the spine (vertebrae), and the NHS notes that in some people even a cough or sneeze can cause a broken rib.

The Royal Osteoporosis Society points out that strong bones should be able to withstand a bump, or a fall from standing height. A bone that breaks that easily is often the first sign that bones have become weaker.

Signs of a spinal fracture

Broken bones in the spine are easy to miss, because they do not always follow an obvious fall. The Royal Osteoporosis Society lists these signs:

• back pain that is not explained, sometimes with muscle spasms
• loss of height
• a curved spine or a change in posture

The NHS notes that some older people develop a stooped, bent-forward posture when bones in the spine have broken. Back pain has many causes, and most back pain is not caused by osteoporosis, so speak to a GP rather than assuming either way. Our guide to back pain and which scan explains when imaging helps.

Risk factors for osteoporosis

The NHS says losing bone is a normal part of ageing, but some people lose bone much faster than normal. Women lose bone rapidly in the first few years after the menopause. Women are more at risk than men, particularly if the menopause begins early, before the age of 45. Other risk factors listed by the NHS include:

• taking high-dose steroid tablets for more than 3 months
• a parent who has had a hip fracture
• some inflammatory, hormone-related and other medical conditions, and some medicines
• having a low body mass index, or a history of eating disorders
• not exercising regularly
• heavy drinking and smoking

Who is offered a DEXA scan

A DEXA (or DXA) scan measures bone density using very low dose X-rays. The Royal Osteoporosis Society says the radiation is similar to the amount we get from about three days of normal life, and that the scan usually looks at the lower spine and hips, sometimes the wrist.

In the NHS, a DEXA scan is not usually the first step. NICE guidance (CG146) recommends considering a fracture risk assessment in all women aged 65 and over and all men aged 75 and over, and in younger people with risk factors such as a previous fragility fracture, steroid use, a history of falls, a family history of hip fracture, low body mass index, smoking, or drinking more than 14 units of alcohol a week. That assessment uses a tool such as FRAX or QFracture.

NICE advises against routinely measuring bone density without that prior risk assessment. It recommends considering a DEXA scan for people whose fracture risk is close to the threshold where treatment would be recommended, and before starting some treatments that can quickly reduce bone density. The NHS says that if your doctor suspects osteoporosis, they may refer you for a bone density scan, which is a short, painless procedure that takes 10 to 20 minutes.

What a DEXA scan result tells you

The scan gives a T-score, which compares your bone density with that of a healthy young adult. The NHS explains that a score above minus 1 is normal, between minus 1 and minus 2.5 is defined as osteopenia (bone loss), and below minus 2.5 is defined as osteoporosis.

The Royal Osteoporosis Society stresses that a bone density scan is just one part of assessing bone strength. Doctors combine the result with a fracture risk assessment to decide whether treatment would help. Our guide to DEXA bone density scans explains the scan in more detail.

When to speak to a GP

The Royal Osteoporosis Society suggests talking to a doctor about your fracture risk if you have broken a bone easily, particularly if you are over 50 or have been through the menopause. A GP can carry out a fracture risk assessment and arrange a DEXA scan if it is needed.

If you have a fall and think you may have broken a bone, or you cannot put weight on a leg after a fall, get urgent medical help through NHS 111, A&E or 999 depending on how serious it is.

Having a DEXA scan privately

DEXA uses ionising radiation, so under the Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R) every scan must be requested by a referrer and justified. Private clinics often arrange this through their own doctor or a clinical review. Our guide on how to get a DEXA scan explains the routes, and the result is reported by an appropriately qualified clinician. The clinic will tell you how long its report takes.

Prices vary by clinic and region. Clinics on FindScan publish their own prices and we show them as set. Visit our DEXA scan page or see DEXA clinics near you, then send an enquiry to the clinic you choose.