Key takeaways
- Osteoporosis does not have official stages, but rather differing levels of severity based on bone density. These levels range from normal bone density to osteopenia (a precursor to osteoporosis) and, finally, to osteoporosis.
- Doctors use bone mineral density tests, like DXA scans, to diagnose osteoporosis and determine its severity. Doctors report the findings of the DXA scan using a T-score, which represents a person’s bone density in comparison to a typical young adult. T-scores from these tests indicate typical bone density, osteopenia, or osteoporosis, and guide treatment decisions.
- Lifestyle changes and medical treatments can help manage bone loss and reduce fracture risk. These interventions can slow, stop, or even somewhat reverse osteoporosis, improving overall bone health.
Osteoporosis develops when bone density, which determines bone strength, decreases. It is a progressive condition, but not everyone experiences progression, especially if they receive treatment.
Additionally, osteoporosis usually has no symptoms until a person breaks a bone.
This article explains the different stages of osteoporosis and how doctors diagnose each stage.
Osteoporosis does not have official, clinically recognized stages, but it can have differing levels of severity. Not everyone progresses through all these levels, though. To understand this, it is helpful to know how osteoporosis develops.
According to the
Osteoporosis develops when the body stops replacing all the lost bone, resulting in a decline in bone strength over time.
Some loss in bone density is natural as people age. Typically, bone density peaks
However, various factors can speed up this process, such as menopause, smoking, underlying conditions, and certain medications.
Other factors, such as malnutrition or a low body weight, can also prevent people from reaching peak bone mass when they are younger. Both scenarios can increase the risk of weaker bones later on.
Below are the terms doctors use to describe the severity of bone density loss.
The precursor to osteoporosis is osteopenia, which refers to a loss of bone density that is
Osteopenia increases the risk of developing osteoporosis, but the United Kingdom’s National Health Service (NHS) notes that osteopenia does not always develop into osteoporosis.
Typically, osteopenia has no symptoms. Medical treatment and lifestyle changes may help to reduce the risk of osteopenia progressing any further. These may include:
- getting more calcium from the diet
- getting enough vitamin D from food, supplements, or sunlight
- exercising regularly
- stopping smoking
- limiting alcohol intake
- treating other conditions that may affect bone health
If osteopenia does progress, it becomes osteoporosis.
Although an individual may still not have any symptoms, their bone loss is exceeding their bone growth and putting them at higher risk of fractures.
There are treatments to slow, stop, or even somewhat reverse osteoporosis. Examples include medications such as bisphosphonates, which
People with osteoporosis can break bones more easily than usual, such as from a minor fall or injury. This is when osteoporosis generally causes symptoms and has the highest risk of complications.
There are several reasons for this.
- Healing times: Broken bones take time to heal, which may mean a person spends longer in the hospital or on bed rest. Some fractures may need medical intervention.
- Increased risk of falls: Extended rest after an injury may result in a loss of muscle strength or balance, increasing the risk of future falls.
- Spine changes: Bone loss in the spine can lead to spinal fractures,
many of which cause no symptoms. Over time, though, these fractures can result in visible changes to the spine, such as a loss of height or stooped posture. - Pain or loss of mobility: Broken bones or spine changes can cause pain or difficulty moving. Sometimes, these symptoms may become chronic.
However, it is important to note that medical professionals can help people reduce the risk of fractures and aid healing if one occurs. They may recommend:
- adapting the home to remove trip hazards
- regular sight and hearing tests
- safe forms of exercise
- physical therapy
Doctors diagnose osteoporosis via a bone mineral density test, often a dual-energy X-ray absorptiometry (DXA) scan. This helps to identify if a person has the condition and, if so, how severe it is.
Doctors use DXA tests to determine the bone density of central bones, such as the hips or spine. For
The score may show:
- Typical bone density: A person with a T-score of -1 or above has bone density in the typical range. They do not have osteoporosis.
- Osteopenia: Someone with a T-score between -1.0 and -2.5 indicates osteopenia, which is the precursor to osteoporosis. At this stage of diagnosis, doctors will use a Fracture Risk Assessment Tool (FRAX) score to see if the patient needs treatment.
- Osteoporosis: A T-score of -2.5 or below can indicate osteoporosis. A person with this condition is more likely to need treatment as they are at a higher risk of fractures.
Premenopausal or younger adults will have a Z-score rather than a T-score. If the score is 2.0- or less, bone density is low. They may have osteoporosis.
Osteoporosis does not have distinct numbered stages. Instead, the precursor to osteoporosis is known as osteopenia, which is a milder form of bone density loss. Osteopenia can progress to osteoporosis, but it does not for everyone.
Lifestyle changes, such as changes in diet and stopping smoking, can reduce the risk of progression. There are also medical treatments to slow or stop bone loss.
Doctors can identify if a person needs these treatments by performing bone density scans. Anyone with concerns about their bone health should speak with a medical professional.