Osteoporosis announces itself with a fracture unless it is found first. This checklist, modeled on the International Osteoporosis Foundation’s one minute test, counts the nine strongest everyday risk factors, from age and sex through steroid use to parental hip fracture. Three or more factors generally justify asking your doctor about a bone density scan.
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Half of women and a fifth of men past fifty will suffer an osteoporotic fracture, yet bone loss itself causes no symptoms until the snap. Screening therefore starts with risk factors rather than scans, and a handful of questions identifies most of the people who need a DEXA.
The Nine Factors
Age past sixty and female sex are the immovable two, since estrogen withdrawal after menopause accelerates bone loss for a decade. A previous fragility fracture, breaking a bone from a standing height fall, is the single loudest alarm. A parent’s hip fracture doubles personal risk through inheritance. Long term corticosteroids thin bone directly. Smoking and heavy drinking both poison bone building cells. A BMI under nineteen removes the mechanical loading that keeps bone strong, and losing more than three centimeters of height or developing a stooped back signals silent vertebral fractures already happening.
From Checklist to Scan
Guidelines recommend routine DEXA for all women past sixty five and men past seventy, and earlier for anyone carrying these factors. The scan’s T-score plus clinical factors feed fracture risk calculators that decide between lifestyle measures and medication.
The Modifiable Share
Weight bearing exercise, adequate calcium and vitamin D, smoking cessation and alcohol moderation are the levers anyone can pull at any age. Bone responds to loading throughout life, so starting at sixty still beats not starting.
Treated early, osteoporosis is one of medicine’s success stories, with modern agents cutting hip fracture risk by half. The tragedy is timing, most patients meet the diagnosis through the fracture it should have prevented.