Osteoporosis, explained | Diagnosis & treatment in Australia

Understand osteoporosis

Osteoporosis makes bones more fragile, so they can break after a small fall or everyday strain. It often causes no symptoms until a fracture occurs.

The goal of care is to prevent fractures, preserve movement and protect independence. A scan is one part of the picture: your fracture history, age, falls and other health conditions also matter.

A small fall can be a big signal.

A fracture after a fall from standing height or less is called a minimal-trauma or fragility fracture. After age 50, it should trigger a bone-health assessment, even if the scan is not in the osteoporosis range.

Sources: 02, 14

How osteoporosis is diagnosed

Start with the whole story

Your clinician asks about previous fractures, falls, height loss, family history, menopause or low testosterone, nutrition, smoking, alcohol and medicines. Long-term oral steroids and some cancer treatments can raise risk.

Measure bone density with DXA

A DXA (also called DEXA) scan usually measures the hip and lower spine. It uses a small amount of X-ray radiation. Tell the scanning service if you might be pregnant.

Making sense of a T-score

A comparison with the bone density of a healthy young adult.

−1.0 or above: Normal bone-density range
Below −1.0, above −2.5: Low bone density (osteopenia)
−2.5 or below: Osteoporosis range

These categories apply to postmenopausal women and men aged 50 and over. Younger people need a different interpretation, usually including Z-scores and specialist assessment; DXA alone does not establish their diagnosis.

A hip or vertebral fragility fracture can support a clinical diagnosis without waiting for a low T-score. Osteopenia can still carry substantial fracture risk.

When might a scan or spine image be considered?

Discuss DXA if you are 70 or older, have had a fragility fracture after 50, or have important risk factors. New back pain or loss of height may prompt imaging for a vertebral fracture. Medicare eligibility and timing depend on the indication; ask the referring practice.

Sources: 02, 03, 05, 15

Look beyond the scan

Estimate the chance of a future fracture

Clinicians may use the Australian FRAX model to combine risk factors with, when available, femoral-neck bone density. It estimates 10-year fracture probability. A score supports clinical judgement; it does not diagnose osteoporosis or select a medicine on its own.

Recent fractures deserve prompt follow-up.

A recent hip or spinal fracture, multiple fractures, a fracture during treatment or a very high estimated risk may warrant early referral to a bone specialist to consider bone-building treatment.

Check for treatable contributors

Conditions such as coeliac disease, thyroid or parathyroid disorders, kidney disease and hormone deficiency may contribute to bone loss. Medicines and nutrition also need review.

Clinical detail: tests for secondary causes

Tests are chosen for the person, rather than self-ordered. Initial assessment may include a blood count, renal and liver function, calcium, phosphate, vitamin D, parathyroid hormone, thyroid function and inflammatory markers. Further testing may look for coeliac disease, myeloma, hormone deficiency or other suspected causes.

Sources: 04, 05, 14

The foundations of stronger bones

MOVE

Build strength and balance

Combine progressive resistance training, appropriate weight-bearing activity and balance work. Walking is useful, but is not a complete bone-strengthening programme.

With osteoporosis or a previous fracture, a physiotherapist or accredited exercise physiologist can tailor loading safely. Do not start high-impact exercise or heavy spinal bending without advice.

NOURISH

Food first, supplements if needed

Include calcium-rich foods and enough protein. The usual calcium target is 1,000 mg/day, rising to 1,300 mg/day for women over 50 and men over 70, from food and supplements combined.

Use supplements to fill an identified gap, with advice. They do not replace osteoporosis medicine when fracture risk is high.

SUPPORT

Keep vitamin D adequate

Vitamin D helps the body absorb calcium. People at risk of deficiency may need a blood test and a tailored supplement plan.

Sun exposure advice depends on skin type, season and location. Follow sun-protection guidance; do not use sunburn or prolonged exposure to treat deficiency.

PROTECT

Reduce the chance of a fall

Review balance, eyesight, footwear and medicines that cause dizziness. Improve lighting, remove trip hazards and ask about a home-safety assessment if needed.

Stop smoking and avoid excessive alcohol. After a fracture, rehabilitation and a prevention plan matter as much as healing the break.

Sources: 09, 10, 11, 14

Choose treatment around fracture risk

Treatment is a shared decision. The best option depends on fracture risk, kidney function, other conditions, preferences and the ability to keep to the schedule.

Medicines are often recommended after a fragility fracture or with osteoporosis-range bone density. Some people with osteopenia also benefit when overall risk is high. Very-high-risk patients may benefit from starting with a bone-building medicine.

SLOW BONE LOSS

Bisphosphonates

Alendronate · Risedronate · Zoledronic acid

Tablets or an intravenous infusion reduce fracture risk. Oral options need product-specific instructions for food, water and remaining upright; check these with a pharmacist.

Swallowing or oesophageal problems may rule out tablets. Kidney function, calcium and vitamin D are checked before treatment. Infusions may cause a temporary flu-like reaction. Any planned pause needs an individual risk review and follow-up.

Sources: 06

SLOW BONE LOSS

Denosumab

A scheduled injection every six months

Denosumab reduces bone breakdown. It can be an option when other treatments are unsuitable, but requires a reliable long-term plan.

Correct low calcium before starting and ensure adequate vitamin D and calcium intake. Severe kidney impairment or dialysis increases the risk of serious low calcium and needs specialist input and monitoring.

Denosumab must not be stopped or delayed without a plan.

Its effect wears off quickly. Missing or stopping injections can cause rapid bone loss and multiple spinal fractures. If a dose is overdue, contact the prescriber promptly. If stopping is necessary, the clinician must arrange timely follow-on treatment, usually a bisphosphonate. A “drug holiday” is not appropriate.

Sources: 07

BUILD BONE

Specialist-led therapies

Romosozumab · Teriparatide · Abaloparatide

Bone-building treatment may be considered first for very high fracture risk. Courses are time-limited and need follow-on antiresorptive medicine to maintain benefit. Eligibility and PBS access differ; a bone specialist checks the current criteria.

Romosozumab is contraindicated in anyone with a previous heart attack or stroke in Australia. Cardiovascular risk must be assessed before treatment.

Sources: 05, 08, 16, 17

What about menopausal hormone therapy?

Menopausal hormone therapy can reduce bone loss and fractures in selected women, especially when menopausal symptoms also need treatment. Suitability depends on age, time since menopause and personal risks, including blood clots and hormone-sensitive cancer. It needs an individual discussion rather than a blanket recommendation.

Sources: 18

Make follow-up part of the plan

BEFORE STARTING

Agree on a treatment plan

Discuss benefits and harms, kidney function, calcium and vitamin D, dental health, costs and how the medicine fits your life. Set the next appointment before leaving.

3–6 MONTHS

Review how it is going

Check side effects, correct use, missed doses, new fractures and falls. Clinical reviews generally continue every 6–12 months, adjusted to the treatment and person.

LONGER TERM

Reassess fracture risk

Repeat DXA is often considered around two years, preferably on the same machine; some circumstances justify earlier testing. A new fracture, new back pain or height loss should prompt review rather than waiting for the next scan.

Dental care and rare medicine complications

Jaw osteonecrosis and unusual thigh-bone fractures are rare complications of some osteoporosis medicines. Keep regular dental care and tell your dentist what you take. Discuss planned invasive dental work with both dentist and prescriber; do not stop treatment yourself. Report persistent thigh or groin pain, a non-healing dental wound or jaw symptoms.

For people at high fracture risk, preventing fractures usually outweighs these rare risks. The balance is reviewed over time.

Sources: 05, 06, 12, 13

Your next conversation

Take a copy of your scan report and a medicine list to your appointment. These questions can help:

Have I had a fragility fracture, and what is my overall fracture risk?
Do I need tests for another cause of bone loss?
Would I benefit from a medicine or a bone specialist review?
What is the schedule, and what happens if I need to stop or switch?
What exercise is safe for me, and when should we review progress?

When to seek urgent help

Seek urgent assessment after a fall if you have severe hip or back pain or cannot bear weight. New leg weakness, loss of bladder or bowel control, or numbness around the groin with back pain needs emergency care. Call 000 for a medical emergency.

Healthdirect: urgent back-pain symptoms

For general bone-health information, visit Healthy Bones Australia or call its helpline on 1800 242 141.

Evidence & scope

This independent educational guide focuses on Australian adults, particularly postmenopausal women and men over 50. It cannot diagnose a condition or replace individual medical care, product information or prescribing advice. Children, younger adults, pregnancy and complex kidney disease need a different approach.

Sources checked 2 October 2026, including the September 2026 Healthy Bones Australia update. This date is a source check, not a claim of independent clinician review. Medicine availability and PBS criteria can change.