Osteoporosis thins and weakens bone until it breaks from a fall or strain that would not injure healthy bone. It causes no symptoms while it develops. For many people the first sign is a fractured wrist, a hip fracture, or a spinal compression fracture that shows up as lost height or a stooped back. By then the bone loss has been underway for years.
Screening exists to find that loss before a fracture does. A bone density scan measures how dense your bones are at the hip and spine, the sites where fractures matter most, and combined with your other risk factors it estimates how likely you are to break a bone over the coming years. That estimate, not the scan number alone, decides whether you need treatment.
At NYMD Center, osteoporosis screening is part of routine internal medicine care. We decide who should be tested, interpret the results in the context of your whole health, and manage prevention and treatment within the practice.
Who should be screened
The U.S. Preventive Services Task Force recommends osteoporosis screening for all women 65 and older, and for postmenopausal women younger than 65 who are at increased risk of fracture based on a clinical risk assessment. Risk factors the Task Force names include low body weight, a parent who broke a hip, cigarette smoking and heavy alcohol use. For a woman under 65 with one or more of these, we use a risk assessment tool to decide whether a scan is warranted.
For men, the Task Force concluded that the evidence is not yet sufficient to recommend for or against routine screening, and that clinicians should use judgment. It also notes that its recommendation does not cover people whose bone loss stems from a medical condition or medication. Those are exactly the men we see often. Men with low testosterone, men taking long-term steroid medication such as prednisone, and men receiving androgen-deprivation therapy for prostate cancer lose bone faster than their peers. Because our urology and internal medicine teams work in the same practice, a man starting hormone-blocking treatment for prostate cancer, or being evaluated for low testosterone, can have his bone health checked as part of that care rather than after a fracture.
Other situations that raise risk for anyone include a previous fracture from a minor fall, early menopause, rheumatoid arthritis, long-term use of certain seizure, acid-suppressing or cancer medications, an overactive thyroid or parathyroid, celiac disease or other conditions that impair absorption, and a history of eating very little or losing a lot of weight.
How we evaluate bone health at NYMD Center
The evaluation begins with a history focused on fractures, falls, medications, menstrual and menopausal history, family history, diet, alcohol and smoking. We measure height, since lost height can signal spine fractures that were never diagnosed, and check balance and gait.
The central test is a DEXA scan (dual-energy x-ray absorptiometry). You lie on a padded table for a few minutes while a scanner arm passes over your hip and lower spine. It is painless, requires no injection, and uses a very low dose of radiation, as MedlinePlus explains. Results are reported as a T-score, which compares your bone density with that of a healthy young adult. A T-score at or below -2.5 defines osteoporosis, and a score between -1 and -2.5 is called low bone mass, or osteopenia.
We then combine the scan with your risk factors using FRAX, a calculator that estimates your ten-year probability of a hip fracture and of any major osteoporotic fracture. Two people with the same T-score can have very different fracture risks, and FRAX helps us decide who benefits from medication and who is better served by prevention alone.
When bone density is low, blood work looks for causes that can be corrected: vitamin D level, calcium, kidney and liver function, thyroid function, and in men a testosterone level. Finding a treatable cause changes the plan.
Prevention and treatment, least invasive first
Exercise and fall prevention
Weight-bearing exercise such as brisk walking and stair climbing, together with resistance training two or three times a week, helps maintain bone and builds the muscle strength and balance that prevent falls. Because most osteoporotic fractures follow a fall, reviewing medications that cause dizziness, correcting vision, and removing tripping hazards at home matter as much as the scan. These steps carry little risk and are the foundation for everyone, whether or not medication is needed.
Calcium, vitamin D and daily habits
We aim for adequate calcium mainly from food, such as dairy, fortified alternatives, leafy greens and canned fish with bones, and check vitamin D so a deficiency can be corrected. Supplements are used to fill a real gap rather than taken by default. Stopping smoking and keeping alcohol moderate also protect bone.
Treating the underlying cause
If low bone density is driven by a medication, a thyroid or parathyroid problem, or hormone deficiency, addressing that cause is part of treatment. For men with confirmed low testosterone, hormone replacement may be considered as part of a broader plan. For women around menopause, estrogen therapy protects bone and may be discussed alongside our menopause care when it also makes sense for symptoms.
Bone-protecting medication
When fracture risk is high, medication meaningfully reduces the chance of a break. Oral bisphosphonates, taken weekly or monthly, are usually the first choice. They must be taken on an empty stomach with water while staying upright, and can upset the stomach. Other options include a yearly intravenous infusion, a twice-yearly injection, and bone-building injectable drugs for people at very high risk. Rare but serious side effects, including jaw bone problems and unusual thigh fractures, are discussed openly, and for most people at high risk the benefit in fractures prevented clearly outweighs them. We review treatment duration periodically rather than continuing indefinitely without reassessment.
What to expect at your visit
Screening starts with an ordinary visit, often combined with your annual exam. On the day of the DEXA scan, skip calcium supplements for 24 hours, wear clothes without metal buttons or zippers, and tell us if you might be pregnant or have recently had a barium study or contrast scan. The scan takes only minutes. We review the results with you, explain your fracture risk in plain terms, and agree on a plan and on when a repeat scan would be useful, which depends on your starting result and whether you begin treatment.
When to seek care promptly
Sudden back pain after lifting, bending or a minor fall, a noticeable loss of height, or a new curve in the upper back can signal a spinal compression fracture and should be evaluated soon. Any fall that leaves you unable to bear weight on a leg, or with severe hip or groin pain, needs emergency care.
Questions patients ask
Who should get a bone density test?
The U.S. Preventive Services Task Force recommends screening for all women 65 and older and for younger postmenopausal women at increased fracture risk. For men, the evidence is not settled, so we decide case by case. We often test men with low testosterone, long-term steroid use, or hormone-blocking treatment for prostate cancer, and anyone who has broken a bone in a minor fall.
What does a DEXA scan feel like?
It is painless. You lie on a padded table for a few minutes while a scanner arm passes over your hip and lower spine. There are no needles and the radiation dose is very low. Skip calcium supplements for 24 hours beforehand, wear clothes without metal, and tell us if you might be pregnant.
What do T-scores mean?
A T-score compares your bone density with that of a healthy young adult. A score of -1 or higher is normal, between -1 and -2.5 is low bone mass (osteopenia), and -2.5 or lower is osteoporosis. We combine your score with other risk factors, using the FRAX calculator, to estimate your actual chance of a fracture.
How often should bone density be rechecked?
There is no single interval that fits everyone. People with normal results may not need another scan for several years, while those with low bone mass, ongoing risk factors, or who have started treatment are usually rechecked sooner. We set the timing based on your starting result and your plan rather than repeating scans on a fixed schedule.
Can osteoporosis be reversed?
Bone density can improve, and fracture risk can be reduced substantially. Exercise, fall prevention, adequate calcium and vitamin D, and correcting underlying causes help everyone. For people at high risk, medications slow bone loss, and some newer injectable drugs actively build bone. The goal of treatment is preventing fractures, not just raising the scan number.
Why would a man need osteoporosis screening?
Men lose bone too, and certain treatments speed it up. Low testosterone, long-term steroid medication, and androgen-deprivation therapy for prostate cancer all increase bone loss. Because our urology and internal medicine teams work together, men on these treatments can have bone health checked as part of their care, before a fracture occurs.