Early detection of osteoporosis is important because early treatment can slow the progress of the disease. A physician should compile a medical history and conduct a physical examination. Topics that will be discussed include the patient’s:

• Reproductive history and time of menopause, or, for men, symptoms of low testosterone levels
• Past or present medical conditions
• Medications taken
• Lifelong intake of calcium
• Lifelong exercise patterns
• Habits including use of tobacco and alcohol

Various blood tests may be performed to rule out other conditions that may cause bone thinning (osteopenia). These conditions include:

• Osteomalacia. Demineralization, softening and weakening of the bone.
  
  
• Multiple myeloma. A cancerous tumor of the bone marrow.
  
  
• Hyperthyroidism or hypothyroidism. Excessive or deficient activity of the thyroid gland, respectively.
  
  
• Renal insufficiency. Occurs when the kidneys cannot function adequately to maintain a normal state of health.

The best way to detect osteoporosis is by using one or more of several devices that measure bone density. These include:

• DEXA scan (dual energy x-ray absorptiometry). The most popular method of gauging bone density in patients suspected of osteoporosis. It measures the density of bones in the spine, hips and wrists, the bones most likely to be fractured as a result of osteoporosis. During the test, an x-ray detector scans bone regions, and the varying amounts of x-rays that pass through the bone are measured. The information is then displayed as a color-coded, computerized image that reveals the patient’s bone density. Repeat DEXA tests can help reveal changes in the bones over time. DEXA exposes patients to minimal amounts of radiation.
  
  
• Single-photon absorptiometry. Used to measure bone density of the forearms and heels.
  
  
• Dual-photon absorptiometry. Used to measure bone density of the hips and spine.
  
  
• CAT scan (computed axial tomography). A noninvasive or minimally invasive test that uses a rotating x-ray device to create detailed cross-sectional images (or slices) of body parts. It measures bone density in the spine and may be used as an alternative to DEXA in some cases.
  
  
• Ultrasound. Imaging technique that uses high-frequency sound waves to visualize internal body structures. It can be used to measure the density of the heel.

The National Osteoporosis Foundation recommends bone density tests for women who are not taking hormone replacement therapy (HRT) and fall into any of the following categories:

• Use medications, such as corticosteroids, that cause osteoporosis
  
  
• Have type 1 diabetes, liver disease, kidney disease or family history of osteoporosis
  
  
• Experience early menopause
  
  
• Are postmenopausal, over age 50 with at least one risk factor for osteoporosis
  
  
• Are postmenopausal, over age 65 and have never had a bone density test

Men with risk factors for osteoporosis are advised to ask their physician about screening for this disease, which is often overlooked in males. There is a popular misconception, even among some doctors, that osteoporosis is a “female disease,” but it also affects millions of men, who are less likely than women to recover from osteoporotic fractures and may be more likely to suffer additional fractures. Many informed physicians are now recommending routine bone density screening tests for men 70 and older, or starting at a younger age if there are additional risk factors.

Bone density measurements are expressed as T–scores, which reflect the patient’s bone density compared to that of a healthy adult of the same sex. A patient’s bone density will also be compared to a Z-score, which is the number of standard deviations above or below what is expected for someone of the same age, sex, weight and ethnic or racial origin.

Dental x-rays over time may also help diagnose osteoporosis by revealing bone loss in the jaw, according to recent research.