Osteoporosis progresses in four stages, during which the bones become weaker and more prone to fractures. However, health experts consider the first two stages to be precursors to the condition.

Osteoporosis develops when bone density decreases in a person’s body. People refer to osteoporosis as a silent bone disease because there are usually no symptoms. As a result, individuals may not know that they have the condition until they break a bone.

Bone fractures often occur in the later stages of the disease due to a gradual decrease in bone density. Bone density refers to the mass and strength of the bone.

According to the International Osteoporosis Foundation, a bone density scan is the best way to know if someone has osteoporosis.

This article explains the different stages of osteoporosis and how doctors diagnose each stage.

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The National Institute on Aging notes that the human body breaks down old bone and replaces it.

At stage 1 of osteoporosis, a person’s bone loss and bone formation develop at the same rate. This means they no longer make more bone material than they are losing.

A doctor may consider this stage 1 of osteoporosis because the formation of new bone does not outpace a person’s bone loss.

There are no symptoms at this stage.

This is the stage before a doctor diagnoses someone with osteoporosis. At this point, an individual has a lower bone mass or bone density than usual for their age.

Health experts call this osteopenia, and bone loss occurs faster than bone formation. Despite this, an individual may still not experience any symptoms, and their bones are less likely to fracture because they have not yet deteriorated.

The United Kingdom’s National Health Service (NHS) notes that osteopenia does not always develop into osteoporosis. A person can take steps to reduce their risk of developing osteoporosis.

When someone has reached the third stage of osteoporosis, a doctor is likely to diagnose them with the condition.

Although an individual may still not have any symptoms, at this stage, their bone loss is likely exceeding their bone growth and putting them at higher risk of bone fractures.

Sometimes, a person may break a bone from experiencing a minor fall that would not have previously resulted in a fracture.

Stage 4 is the most severe stage of osteoporosis. The risk of bone fracture is higher, and the individual may also start having symptoms.

Severe bone loss can lead to noticeable changes in a person’s spine, such as height loss or stooped posture.

A doctor may recommend a bone mineral density (BMD) test if they suspect an individual has osteoporosis.

This is the most common test for measuring BMD, and the most common method is a dual energy X-ray absorptiometry (DXA) scan.

Doctors use DXA tests to determine the bone density of central bones, such as the hips or spine. They will also use a T-score to report the test results. The T-score result compares the individual’s bone mass with those of a typical young adult.

The scoring per stage is as follows:

  • Stage 1: A person with a T-score between +1 and -1 has a bone density in the typical range.
  • Stage 2: Someone with a T-score between -1.0 and -2.5 indicates osteopenia. At this stage of diagnosis, doctors will use a Fracture Risk Assessment Tool (FRAX) score to see if the patient may need treatment.
  • Stage 3: A T-score of -2.5 or below can indicate osteoporosis. The person will most likely need treatment as they have a high risk of fractures.
  • Stage 4: At this stage, an individual may have a T-score of -2.5 or lower and present with at least one fragility fracture.

A DXA scan can reliably detect a person’s risk of bone fractures. However, it may be less effective for people who have previously fractured their bones and those with obesity.

A 2020 study suggests that obesity may lead to an increase in bone density because it has associations with higher hormone levels, which may protect the bones.

There are four stages of osteoporosis. As the condition progresses, an individual’s bones get weaker over time until they start to have fractures.

In the early stages of osteoporosis, a person is not likely to have any symptoms. They may also not know that they have the condition until they experience a bone fracture.

A doctor can treat osteoporosis with medication and lifestyle changes that help slow bone loss and reduce the risk of bone fractures, respectively.