The goals with testing are to determine whether a patient has osteoporosis, has low bone mass and an increased risk of developing the disease, is menopausal and/or hormone-deficient, and/or has an underlying condition that may be causing or exacerbating bone loss. Testing may be done to screen for bone density loss or to evaluate bone status when a person has an unexpected bone fracture and may be used to monitor osteoporosis therapy for effectiveness. Diagnostic imaging, a non-laboratory test, is used in the Bone Mineral Density test, the primary screening and diagnostic test for osteoporosis.

Non-Laboratory Tests
The bone mineral density (BMD) test is the primary test used to identify osteoporosis and low bone mass. One of the preferred and most accurate ways to measure BMD is Dexa-Scan (dual-energy xray absorptiometry or DXA). It uses a low energy x-ray to evaluate bone density in the hip and/or spine. BMD is often reported in terms of peak bone mass in young adults. A BMD value that is less than 1 standard deviation below the young adult mean is considered normal. BMD in osteopenia has a value between -1 and -2.5 standard deviations below the young adult mean while osteoporosis BMD values are even lower and are at least -2.5 standard deviations below the mean.

Portable BMD screening devices, utilized at some pharmacies, health fairs, etc., are used to scan people’s heels or fingers. These scans are not as accurate as the DXA but may be used as an initial scan. When these tests are positive for decreased bone density, a DXA scan may be performed for confirmation.

Other diagnostic imaging tests that may be done to measure BMD and to detect osteoporosis include CT scans (computerized tomography), X-rays and ultrasounds.

One other diagnostic imaging test used to evaluate the condition of the bones is a bone scan, which is not to be confused with the bone density scan or BMD. While the BMD test is used to identify low bone density that is indicative of osteoporosis and is non-invasive, a bone scan is a nuclear medicine test used to rule out other serious conditions of the bones. To perform this test, a radioactive tracer is injected into a vein in the arm. The tracer then travels through the blood and is absorbed by the bones. The level of radioactivity detected in the bone is evaluated and can point to conditions or diseases such as metastatic cancer, infection, causes of unexplained bone pain, or Paget’s disease. This type of scan can discover problems with the bones much earlier than a regular X-ray and may be ordered when patients have a high frequency of bone fractures.

Laboratory Tests
Blood tests may include:

Bone Markers, blood and urine tests that may sometimes be ordered to help evaluate and monitor the rate of bone resorption and formation include:

Bone resorption tests

Bone formation tests