How do you know if you have high or low bone mass?

Over 54 million Americans have osteoporosis or low bone mass, a silent condition that increases fracture risk.

Knowing how you know if you have high or low bone mass is crucial, as it often has no symptoms until a bone breaks, but understanding the risk factors and testing options is the first step toward proactive health management.

Quick Summary

Determining high or low bone mass typically requires a diagnostic tool like a DEXA scan, as low bone density, known as osteopenia or osteoporosis, often presents with no obvious symptoms. Abnormalities are revealed by comparing your T-score against established benchmarks, while rare cases of high bone density are diagnosed through specialized imaging and evaluation.

Key Points

• DEXA Scan is Key: The most accurate way to determine your bone mass is through a Dual-energy X-ray Absorptiometry (DEXA) scan, which measures bone mineral density.

• T-Scores Reveal Status: DEXA scan results are given as a T-score, where -1.0 or higher is normal, -1.0 to -2.5 is osteopenia, and -2.5 or lower is osteoporosis.

• Low Bone Mass is 'Silent': Low bone density typically shows no symptoms until a fracture occurs, making proactive screening crucial for at-risk individuals.

• High Bone Mass is Rare: Extremely high bone density (osteopetrosis) is a rare genetic disorder and is not a sign of healthy, strong bones.

• Lifestyle Changes Help: Adopting a lifestyle with plenty of calcium, vitamin D, and weight-bearing exercise is essential for building and maintaining strong bones.

Understanding the 'Silent Disease'

Low bone mass, a precursor to osteoporosis, is often called a 'silent disease' because bone loss progresses without any noticeable symptoms. Many people only become aware of their condition after a minor fall results in a fracture. The good news is that advancements in diagnostic tools and a better understanding of risk factors allow for early detection and intervention. Monitoring your bone health is a vital part of healthy aging and senior care, allowing you to take proactive steps to prevent serious fractures and maintain your independence.

Common Risk Factors for Low Bone Mass

While anyone can develop low bone mass, some individuals are at a higher risk. Identifying these factors is the first step toward discussing your bone health with a healthcare provider. Risk factors can be divided into non-modifiable (things you cannot change) and modifiable (lifestyle factors you can influence).

Non-Modifiable Risk Factors

• Age: Bone density naturally declines with age, especially after 30.
• Gender: Postmenopausal women are at a higher risk due to the sharp drop in estrogen levels, a hormone critical for bone density.
• Family History: A genetic predisposition to osteoporosis or a family history of fractures increases your likelihood.
• Ethnicity: Caucasian and Asian women are at a greater risk of developing osteoporosis.
• Body Frame Size: Individuals with small, thin body frames tend to have less bone mass to lose as they age.

Modifiable Risk Factors

• Dietary Deficiencies: Insufficient intake of calcium and vitamin D is a major contributor to low bone density.
• Inactive Lifestyle: Weight-bearing exercise stimulates bone growth. A sedentary lifestyle weakens bones.
• Excessive Alcohol Consumption: Drinking more than two alcoholic beverages daily can increase bone loss.
• Smoking: Tobacco use has been linked to decreased bone density.
• Certain Medications: Long-term use of corticosteroids, some diuretics, and proton pump inhibitors can accelerate bone loss.

The Gold Standard for Diagnosis: The DEXA Scan

The definitive way to know if you have high or low bone mass is through a Dual-energy X-ray Absorptiometry (DEXA) scan. This simple, non-invasive, low-radiation procedure is the gold standard for measuring bone mineral density (BMD), typically at the hip and spine, where fragility fractures are most common.

How a DEXA Scan Works

1. Preparation: No special preparation is needed, though you may be advised to stop taking calcium supplements 24 hours prior.
2. Procedure: You will lie on a padded table while a mechanical arm passes over your body, sending low-dose X-rays through your bones.
3. Duration: The entire process is quick, often taking only 10 to 15 minutes.

Interpreting Your DEXA Scan Results

Your DEXA scan will produce a T-score, which compares your bone density to that of a healthy young adult of the same gender. The results are categorized as follows:

1. Normal Bone Density: A T-score of -1.0 or higher. This indicates your bone mass is healthy and within the expected range.
2. Low Bone Mass (Osteopenia): A T-score between -1.0 and -2.5. This means your bone density is lower than average, increasing your risk of developing osteoporosis. Lifestyle changes and monitoring are often recommended.
3. Osteoporosis: A T-score of -2.5 or lower. This is a diagnosis of osteoporosis, indicating significantly reduced bone density and a high risk of fractures.

Your doctor may also use a Z-score, which compares your BMD to people of your same age, sex, and ethnic background. This is most often used for premenopausal women, men under 50, and children.

What About High Bone Mass?

While low bone mass is a widespread concern, some people have naturally high bone density. In rare cases, abnormally high bone mass, a condition called osteopetrosis, can occur due to genetic disorders. This is not beneficial, as the bones are dense but also brittle and prone to fracture. It is a serious condition that requires specialized medical care, but it is far less common than osteopenia and osteoporosis.

Comparison of Low vs. High Bone Mass

Feature	Low Bone Mass (Osteopenia/Osteoporosis)	High Bone Mass (Osteopetrosis)
Prevalence	Very common, especially in older adults	Extremely rare, typically a genetic disorder
Cause	Loss of bone minerals and density over time	Genetic mutations affecting bone remodeling
Symptoms	Often none until a fracture occurs; can include loss of height, stooped posture	Can include fractures, nerve damage due to bone overgrowth, and other complications
Bone Structure	Porous, thin, and brittle bones	Abnormally dense and solid bones, but also fragile
Fracture Risk	High risk from minor falls or impacts	Paradoxically, a high risk of fracture from impacts due to brittleness
Treatment	Lifestyle changes, supplements, medication	Highly specialized treatment addressing specific symptoms and complications

Lifestyle and Prevention: The Path to Stronger Bones

No matter your current bone density, a healthy lifestyle is the best defense against bone loss. Regular exercise and a balanced diet are cornerstones of any plan to maintain skeletal health. Here are some key strategies:

• Increase Calcium Intake: Aim for 1,200 mg of calcium daily for women over 50 and men over 70. Include sources like dairy products, leafy greens, fortified foods, and supplements if necessary.
• Boost Vitamin D: This vitamin is essential for calcium absorption. Get sunlight exposure and consume vitamin D-rich foods like salmon and fortified milk. Supplements are often recommended, especially for those in northern climates.
• Engage in Weight-Bearing Exercise: Activities like walking, hiking, dancing, and weightlifting put stress on your bones, signaling your body to strengthen them.
• Perform Muscle-Strengthening Exercises: Yoga, pilates, and lifting weights improve muscle strength, which supports the skeleton and improves balance, reducing the risk of falls.
• Avoid Smoking and Limit Alcohol: Both tobacco and excessive alcohol consumption have a detrimental effect on bone density.

For more information on living with osteoporosis and managing your bone health, the Bone Health and Osteoporosis Foundation is an excellent resource.

Conclusion

Knowing your bone mass is essential for preventing fractures and maintaining an active, independent life, especially as you age. Since low bone mass is often symptomless, consulting with your doctor and undergoing a DEXA scan is the most reliable method for diagnosis. While high bone mass is a separate and rare condition, for the vast majority, the focus is on preventing bone loss. By adopting a bone-healthy lifestyle, you can build a strong foundation and reduce your risk of developing osteoporosis, ensuring a healthier future for your skeletal system.

Frequently Asked Questions

What are the early signs of low bone mass?

There are often no early signs of low bone mass, which is why it's referred to as a silent disease. Advanced signs may include a fracture from a minor fall, a gradual loss of height, or the development of a stooped posture.

When should I get a bone density test?

Bone density testing is typically recommended for all women aged 65 and older and men 70 and older. It may be recommended earlier if you have significant risk factors, such as a history of fractures after age 50, a family history of osteoporosis, or certain medical conditions.

Can diet and exercise improve bone mass?

Yes, a diet rich in calcium and vitamin D, combined with regular weight-bearing exercises like walking, hiking, and resistance training, is crucial for building and maintaining strong bone mass.

What is the difference between osteopenia and osteoporosis?

Osteopenia is a condition of low bone mass, a step on the path toward osteoporosis. Osteoporosis is a more severe disease where bones become very porous and fragile, greatly increasing the risk of fractures.

Is high bone mass a good thing?

In most cases, naturally higher bone mass is a positive sign of skeletal strength. However, in rare cases, a genetic condition called osteopetrosis causes abnormally dense but brittle bones, which can lead to complications and increased fracture risk.

How can my doctor assess my fracture risk?

In addition to your DEXA scan T-score, your doctor may use a tool like the FRAX assessment. This tool incorporates other personal risk factors, such as age, gender, medical history, and lifestyle, to estimate your 10-year risk of major osteoporotic fracture.

Do men need to worry about low bone mass?

Yes, while osteoporosis is more common in women, men are also at risk. About one in four men over the age of 50 will break a bone due to osteoporosis. Risk factors are similar to those in women, and screening is typically recommended for men over 70.