Osteoporosis is described as a silent disease because it produces no pain, no visible signs, and no functional limitation until the structural integrity of bone has been compromised enough that a fracture occurs, often from a minor fall or, in severe cases, a cough or the gentle bump against a piece of furniture. By the time this happens, the patient has often been losing bone for years or decades. The diagnosis is made in retrospect, and in many cases the fracture itself is the first clinical event.
DEXA Scanning: What to Know
Dual-energy X-ray absorptiometry measures bone mineral density at the lumbar spine and hip. It is the gold standard for osteoporosis diagnosis and is the only test that can reliably identify bone loss before fracture. In the UK, DEXA scanning is not routinely offered to all post-menopausal women; it is typically triggered by a fracture, a clinical risk factor assessment using the FRAX tool, or a referral from a clinician who has calculated elevated fracture risk. Many women with osteopenia or early osteoporosis are never tested until after a fracture.
Who Should Be Screened
- All women aged 65 and over who have not been tested
- Post-menopausal women under 65 with at least one additional risk factor: family history of hip fracture, smoking, alcohol use, low body weight, prior fracture as an adult
- Anyone who has been on long-term corticosteroid treatment
- Adults with conditions associated with bone loss including coeliac disease, inflammatory bowel disease, hyperthyroidism, or eating disorders
- Women who had early menopause before age 45
- Anyone who has experienced a fragility fracture as an adult
Sources
- Kanis, J.A., et al. (2008). FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis International, 19(4), 385-397.
- NICE Guideline CG146. (2012, updated 2017). Osteoporosis: assessing the risk of fragility fracture. National Institute for Health and Care Excellence.
- International Osteoporosis Foundation. (2019). Capture the Fracture Programme.